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Monitor MondaysAuthor: RACmonitor
Join Chuck Buck every Monday when he welcomes RACmonitor contributing editors and special guests for the latest regulatory audit news and information from CMS, OIG and OMHA. And gain valuable context and perspective that can only be found when youre listening to the long-running and popular Monitor Mondays. Register to attend live here: https://racmonitor.medlearn.com/racmonitor/podcasts/ Language: en-us Genres: Education, Government Contact email: Get it Feed URL: Get it iTunes ID: Get it |
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Did CMS Draw the Right Conclusion about Aetna’s Severity Policy?
Episode 669
Monday, 16 February, 2026
In a January 28 article, Dr. Ronald Hirsch verified that the Centers for Medicare and Medicaid Services (CMS) “has no problem” with the Aetna Severity Payment policy because it “meets the Two-Midnight Rule.” However, there is more to consider than compliance with 42 CFR 412.3. Federal regulations also state Medicare Advantage organizations must comply with Traditional Medicare laws including payment criteria for inpatient admissions at 42 CFR 422.101(b)(2). So the burning question remains: Is CMS disregarding pertinent regulations that could nullify Aetna’s policy?During the next live edition of the venerable Monitor Monday, the Internet broadcast, Cheryl Ericson, senior director of clinical policy and education for the Brundage Group, will address this apparent contradiction.Broadcast segments will also include these instantly recognizable features:· Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. · The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. · Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.· Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.
