Axea Solutions' Partner UF Health Jacksonville Receives Prestigious Awards and Ranking

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Congratulations to UF Health Jacksonville for receiving two prestigious awards and being ranked as one of the top hospitals in multiple areas of care in the latest report released by Healthgrades. Among those achievements are clinical quality awards in cranial neurosurgery and critical care. Axea is proud to partner with UF Health Jacksonville and applauds their commitment to high-quality documentation and coding, which leads to exceptional results.

“Axea Solutions is always thrilled to see our clients thrive in healthcare,” said Axea Solutions CEO Susan Gatehouse. “Our team works alongside the wonderful staff at UF Health Jacksonville to provide education and support and to ensure accurate documentation and quality coding. We applaud the hard work of the UF Health Jacksonville departments, who work so efficiently to ensure public data is handled with care and integrity.”

“I want to thank my team for their contributions to this great success for our valued client."

Axea Solutions CEO Susan Gatehouse Weighs In On EHR

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The October issue of the NAHRI Journal features Axea Solutions CEO Susan Gatehouse in the article, “FOCUS ON CODING: EHR tune-up: Refine EHR implementation and maintenance processes.”

“You’ve made the switch and sailed through

go-live while controlling DNFB—but don’t declare

victory too soon. Seemingly small issues deferred

or unnoticed during the rush of go-live can come

back to bite an organization months or even years

later. Revenue integrity needs to scrutinize reports

to spot revenue issues that can be traced to an

inefficient software setting, poor template design,

or incorrectly configured edits. Having an EHR

means constant change,” says Susan Gatehouse,

RHIA, CPC, CCS, chief executive officer of Axea

Solutions, Inc., in Atlanta.

NAHRI members can view the full article online.

AHIMA 2018 Recap: "Get on Your Feet" and Get Energized

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By: Maureen Kelly

Axea Solutions - Executive Sales Director

The AHIMA 2018 Conference and Exhibit and commemoration of AHIMA’s 90th birthday took full advantage of the event’s location in Miami, Fla., and the newly remodeled Miami Convention Center to create a very energized and exciting program. 

The momentum began the minute the conference was called to order by Diann H. Smith, the current AHIMA president and Vice President of Health Information Management and Clinical Documentation Improvement at Texas Health Resources. Diann was joined on the stage by AHIMA CEO Wylecia Wiggs Harris and the fun and learning began immediately!

The first order of business was for the audience to “Get on Your Feet” and “get up and make it happen – stand up and take some action” - inspired by a Miami music and dance troupe that featured a Gloria Estefan tribute. It was complete with amazing dancing and gymnastic moves that set the stage for a very fast-paced conference. After that performance and Diann’s inspirational speech, the entire audience appeared motivated to make the most of their time at the conference.

There were so many excellent educational sessions at this year’s conference - it was sometimes difficult to choose which event to attend; many of the sessions were standing room only. Topics ranged from coding, auditing, CDI – inpatient and outpatient, HCC and value-based alternative payment models, quality, information governance, analytics, innovation and more!

One session that I found very interesting was Looking to the Future: What ICD-11 Has in Store for HIM Professionals. The speaker, Kathy Giannangelo, explained the many differences between ICD-10 and ICD-11. One of the biggest challenges I see with ICD-11 is that the syntax is much different from what we are used to in ICD-10, and codes can be combined into strings that can be quite long (10+ characters) to support the specificity required with this methodology. This will require our HIM, EHR and other Information Technology solutions to update their systems to handle the new syntax and length of codes. And, of course, coders, CDI, physicians and others will need to be educated so they may accurately document and code patient conditions. While no firm date has been established for the US to implement ICD-11, many countries are already using it and expectations are that we will see this in the states in the 2021 timeframe. 

Axea Solutions CEO Susan Gatehouse Featured In HDM Magazine

Axea Solutions CEO Susan Gatehouse is featured in the September 2018 Health Data Management magazine in the article, “Coding gets an automated assist: Facing ICD-10’s complexity, coders are increasingly getting a hand from computers to do their work.”

“Susan Gatehouse, CEO of Axea Solutions, says in theory CAC sounds great, but it’s shortsighted to believe software by itself could completely replace a human. “It can help, but patience is key,” she says. Gatehouse contends that many hospitals tried CAC software when it was first available, but they gave up on it too soon. It takes time for human coders to review the codes and teach the system to recognize the diagnoses. Systems typically assign too many codes at first, but they get better over time as they learn to better interpret the verbiage used by clinicians, she says. CAC has become more sophisticated since 2015, Gatehouse notes. She predicts that many of the hospitals that stopped using CAC could return to it, and if they are patient, they will find the “tool really works for them.”

View the September 2018 Health Data Management magazine.

Florida HFMA Fall 2018 – Changes in Latitude and Attitude

Author: Maureen Kelly, Executive Director, Axea Solutions

This year’s Florida Hospital Financial Management Association (HFMA) Fall Conference at the Margaritaville Beach Resort in Hollywood, Florida on September 5 – 7, was the perfect location for their fast-paced and innovative program.  Attendees packed the sessions, networking events, and exhibitor hall throughout the conference and took advantage of networking time to discuss strategies and share inventive ideas about navigating the upheaval going on in healthcare revenue cycle operations.  

Transformative Trends

The kick-off speaker, Jacque Sokolov, MD, spoke about the continued evolution of healthcare and why healthcare organizations need to plan for an upheaval in healthcare operations and revenue cycle in his presentation, Management of Transformative Healthcare Trends – How to Expect the Unexpected.  In particular, he discussed the many disruptions that healthcare organizations are experiencing, including:

·       New revenue cycle methodologies,

·       Payment and reimbursement challenges, such as the impact of quality metrics and at-risk payment models, and

·       Aligning hospital and professional services and billing, as the move to value-based healthcare continues, direct employment of physicians increases, and managed care plans require documentation such as hierarchical condition coding

New entries into the traditional healthcare delivery system such as Amazon, Uber, and Microsoft, to name a few, are creating alternatives for healthcare organizations and consumers that are both beneficial and competitive to hospital operations.  Healthcare executives will need to carefully decide how, when, and with whom to align to optimize their business models and serve their communities. 

If you have the opportunity to hear Dr. Sokolov speak at an upcoming event, you should run (not walk) to the meeting room and prepare to be amazed. He definitely has his hand on the pulse of change. 

Compliance Programs: More Important Than Ever

There is a lot going on in the compliance world, and it takes input from everyone in a healthcare organization to ensure that they are meeting compliance goals and objectives. As Joanne Byron, Chief Executive Officer, American Institute of Healthcare Compliance (AIHC) noted in her presentation, 7 Habits of Highly Successful Compliance Programs, an effective program includes:

·       Continued evaluation of medical practices, especially those deemed as high risk,

·       Monitoring for potential conflict of interests,

·       Managing the OIG 7 Step Program, and

·       Handling OIG and CMS self-disclosures.   

The good news is that there are many free government toolkits to help healthcare organizations to comply with the mandated programs via the OIG website. 

Florida State Legislative Initiatives

Ashley Boxer, Corporate Director Government Relations at Memorial Healthcare System, provided an insider’s view to the many healthcare issues that the Florida State Legislature has under consideration.  The pending issues include:

·       Overall healthcare funding,

·       Possible expansion of the state’s Medicaid program, and

·       Potential Certificate of Need (CON) new legislation. 

Ashley provided some essential guidelines on how to communicate with hospitals’ respective representatives to gain their support for legislation important to the hospital.  Most important is to be in regular contact with the representative and their administrative staff, provide high-level responses to questions asked by the representative (bullet points that can be opened on their phone while in session is in progress), and network with lobbyists and government relations personnel from other health systems. 

Click here to learn more about upcoming events hosted by the Florida Hospital Financial Management Association.

Axea Solutions’ team of credentialed HIM and Revenue Cycle experts assist healthcare organizations to review their compliance processes and identify any areas of high performance and those that need improvement. Customized for each healthcare organization, Axea offers one-time service, periodic reviews, or fully managed services. Contact Axea at info@axeasolutions.com or 855.424.4249 to learn more.

Axea Solutions CEO Susan Gatehouse Unveils How to Discover Hidden Financial Pitfalls Post-EHR Transition

Axea Solutions CEO Susan Gatehouse chatted with John Lynn of Healthcare Scene during this week's Healthcare Financial Management Association (HFMA) conference about discovering hidden financial pitfalls post-EHR transition, identifying the root causes of denials, and why healthcare organizations shouldn't always take technology data at face value.

Is your healthcare facility working towards a denial management solution or denial free solutions? Contact Axea Solutions for reducing, remediation, and irradiating your denials.

Axea Solutions CEO Featured in Becker's Hospital Review

Axea Solutions CEO Susan Gatehouse was recently featured in Becker's Hospitals' "Female vendor RCM leaders to know in 2018." 

"A number of healthcare organizations seek out input from vendors for revenue cycle management and financial improvement. At these vendors, there are women who have the expertise to help providers with everything from front-end processes to coding and billing."

Check it out

Axea Solutions Supports Local Efforts To Combat High School Homelessness

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For the past two years, The Place of Forsyth County has celebrated high school graduations with area young people that through many life struggles, including homelessness, have succeeded in receiving their diplomas. 

This year The Place identified 26 deserving seniors who received a decorated jar with eight $25 gift cards! Axea Solutions proudly contributed gift cards, which offered assistance for gas, clothes, fast food, Walmart, Target and entertainment needs. 

"The gifts will bring a smile on the face of kids who beat the odds and are following their dreams!" said Naomi Byrne, The Place Of Forsyth County.

"This is a great local organization that is instrumental to helping those in need right here in our community," said Axea Solutions CEO Susan Gatehouse. "We are proud to support their efforts and we encourage everyone to also lend a hand."

To donate to The Place Of Forsyth, visit http://theplaceofforsyth.org/ or call 770.887.1098.

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The Major Hitter: The 340B Drug Reimbursement Scramble

By: Susan Gatehouse, Axea Solutions CEO

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Another year, another raft of changes from CMS. A major hitter this year is the change in 340B drug reimbursement.

Remember 340B’s history? Signed into law by President George H.W. Bush in 1992, the 340B program was part of the Veteran Affairs Act. It required pharmaceutical companies that participate in Medicaid to provide discounts on certain drugs to facilities that meet specific requirements, primarily that they provide care to medically underserved populations.  

Fast forward to 2016. The Medicare Payment Advisory Committee (MedPAC) started looking into the average payments hospitals were receiving through 340B. The conclusion? Hospitals were making too much money from the program, and reimbursements needed to be decreased.

In late 2017, CMS finalized a proposal to pay hospitals the average sales price (ASP) minus 22.5% for those drugs acquired through the 340B program (except pass-through drugs and vaccines). This is a 28.5% payment difference from 2017 to 2018.

There are exceptions. The payment rate of ASP + 6% will continue for sole community hospitals in rural areas, children’s hospitals, and PPS-exempt cancer hospitals.

Clearly, this new ruling packs a powerful financial punch. However, the savings from this new iteration of 340B are earmarked to meet other facility costs. CMS is implementing this policy in a budget neutral manner by offsetting the estimated $1.65 billion in reductions in drug payments by redistributing that amount to other non-drug services within the OPPS.

A consortium of entities, including the American Hospital Association, Association of American Medical Colleges, America's Essential Hospitals, and three hospitals, sued the Department of Health and Human Services in November 2017, shortly after CMS issued the final ruling on the new reimbursement structure for 340B.

U.S. District Judge Rudolph Contreras dismissed the lawsuit because the proposed cuts had not gone into effect at the time of filing. He did not rule on the merits of the case. The lawsuit is expected to be refiled.

From intensive inventory analysis to programming and assigning the correct modifiers to 340B drug codes, the revisions to this program provide lots of “learning opportunities.” Even facilities that are exempted from these changes are required to use a voluntary modifier to delineate which drugs would fall under the 340B guidelines.

As you grapple with the procedural headaches, uncertain financial impact, and compliance risk that the new version of 340B has wrought, remember that education and training help alleviate at least some of these stressors.

 

Stay tuned! We hope you’ll return for our next blog.

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CDI: Not Just for Inpatient Any More

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By Susan Gatehouse, Axea Solutions CEO

Once considered a luxury of well-endowed major medical facilities, clinical documentation improvement (CDI) specialists have made their way to the mainstream. The majority of facilities nationwide now provide some CDI oversight. The requirement for microscopic review of patient safety indicators, severity, and risk of mortality, along with the complexity of both patient care services and procedures, have made CDI specialists a staple of inpatient hospital coding departments.

The same cannot be said for outpatient areas. It is not a given that outpatient documentation will receive the same attention that is found in the inpatient setting. This may be because "outpatient" and "hospital" are two entities that have not historically been linked. However, healthcare is shifting to more interdependence between the outpatient and inpatient settings. This more holistic approach to patient care carries with it some logistical and reimbursement challenges.

The hospital is not the only place to get services.

Shifting ideals of healthcare and wellness, in addition to changing reimbursement structures, have prompted hospitals to add outpatient services, either on-campus or remotely, to their retinues. Outpatient services offered close to home are attractive to a population that can get a sports physical at a pharmacy, or a flu shot at a big box store. Additionally, the move toward reimbursement linked to total population care may be a factor behind the increase in hospital-affiliated outpatient services.

Outpatient coding continues to have a significant role in the hospital itself, particularly with patients coming into the emergency department. Ambulatory surgery provided in the hospital may lead to observation stays that will be coded as outpatient.

But outpatient coding is so much simpler…

Inpatient coders typically have a greater depth of knowledge because of the more complex patient records that they code. But outpatient coding should not be relegated to second-class status. While inpatients may be sicker and more complex to code, with more outpatient services offered, outpatient coding will become significantly more demanding in terms of volume. That volume equates to a greater piece of overall revenue. The importance of CDI in the outpatient setting becomes evident when the number of records is considered.

In addition, recent OPPS changes for 340B drugs further drive home the point that outpatient services are no longer considered easier to manage and code, and are not necessarily more likely to be accurately reimbursed. 

Why CDI is ALWAYS important

The primary goal of CDI is making the patient record as accurate as possible to ensure that the most correct, most granular picture of the patient is captured. Thorough documentation in any setting can make a huge difference in the outcome for every patient. For outpatient care, physicians need to have and provide excellent documentation in order to treat a patient with whom they may have only a brief encounter, but a potentially life-changing one. Goal one is always the patient's wellbeing.

It is also true that without documentation, the care might be outstanding, but the hospital will not be reimbursed for it. The hospital needs to keep its doors open, whether they be the doors at the main campus or those in an imaging center in the distant suburbs. Outpatient care may offer another stream of revenue for a hospital. It is one that deserves top-notch CDI, just as inpatient does.

Axea Solutions has proven success in assisting outpatient coding departments with the implementation of CDI, coder training, and charge reconciliation procedures. We realize that every dollar counts, and outpatient procedures and services require the same level of detailed attention that inpatient receives.

We hope you’ll return for our next blog.

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