Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging: Expect major Impact on Clinical Workflow, IT and Revenue Cycle
It is important to understand the requirements for Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging as well as the impact to expect on the various aspects of operations upon implementation.
Advanced diagnostic imaging is considered MRI, CT, PET, and Nuclear Medicine (X-rays, Ultrasound, and Fluoroscopy services are not included under the definition of advanced imaging). AUC links a specific clinical condition on presentation, services, and an assessment of the appropriateness of services. AUC’s evidence-based criteria for imaging is meant to assist clinicians in selecting the imaging study that is most likely to improve health care outcomes.
The October issue of the NAHRI Journal features Axea Solutions CEO Susan Gatehouse in the article, “Better together: Creating synergies between CDI and coding”
The article discusses how CDI and coding professionals both bring a high level of expertise and value throughout the revenue cycle and billing process; and how each group of individuals approach documentation from two very distinctly different perspectives.
“Both perspectives are critical, says Susan Gatehouse, RHIA, CPC, CCS, CEO of Axea Solutions, Inc ., particularly with the rise of clinical validation denials. “However, mutual respect and understanding is required. “The endgame is your quality reporting should improve, and also the days in A/R should decrease,” she adds.
Gatehouse affirms that finding a way to bridge the gap and shift processes so that CDI and coding work as a team is critical to ensure accurate and complete documentation, coding, and reimbursement.
NAHRI members can view the article online.
CPT 2020 Newly Released Updates: New Dry Needling and Musculoskeletal add-on codes - Educate your Coders!
Apart from the 244 new, 72 revised and 68 deleted codes in next year’s CPT manual, there have been recent updates on additional code set changes that warrant a mention!
One notable addition to the updates is the new dry needling codes, also known as trigger point dry needling. Linked, yet separate is Trigger point injections, with established codes that have often been problematic for coders – so when you’re adding dry needling it may create additional confusion – be sure to prepare and be proactive. It is also important to pay particular attention to the new musculoskeletal add-on codes for drug delivery device implant and removal.
There is much chatter out there about “Artificial Intelligence” and “Machine Learning.” We’ve been hearing these terms for years, but in the past primarily just in the movies with stories about AI robots taking over the world and such. However, recently, these terms have emerged as commonplace and are actually being applied in a wide variety of ways making astonishing advances throughout various industries, in particular healthcare.
From medical devices to clinical research, the impact this technology has already made in healthcare sectors is significant. It is apparent that healthcare is moving in the direction of AI and machine learning, but do you ever find yourself asking the question, what exactly do these terms mean and what’s the difference between the two?
BY SUSAN GATEHOUSE, CEO, AXEA SOLUTIONS
HIMA held this years’ CDI Summit in the Windy City (aka Chicago, which is a bit more humid than windy this time of year), on July 14-15, 2019. The theme of the conference was Advancing the Documentation Journey, and as promised, it provided many insights on the topic through practical workshops, informative presentations, and several keynote addresses from well-respected industry experts. Here are some highlights from the event -
As organizations continue to move through various implementation models of quality vs. quality payment, it is imperative that no stone is left unturned.
At a macro level, the details of an ICD-10 code assignment may not seem impactful to some departments. So in many cases, the 2020 FY IPPS changes do not pose any significant alterations, certainly not from a surface level. However, taking a closer look into the details, Axea Solutions explored the various changes, and as a result, some areas stood out.
Axea Solutions' Partner Recognized: Two Emory Hospitals named to Becker's Healthcare "100 great hospitals in America" list
Congratulations to Emory Healthcare on two of their hospitals being named in the Becker's Healthcare 2019 list of "100 Great Hospitals in America." Emory Saint Joseph's Hospital and Emory University Hospital, both selected as industry leaders among the nation’s top health care organizations that have achieved advanced accreditation and certification in several specialties.
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.
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.
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.