With concerns of COVID-19 having a disproportionate impact on certain individuals, such as minorities and the elderly, public health experts are requiring more detailed data, provided on a real-time basis – further supporting the reliability and integrity of data being central to healthcare.

By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer ​

While we continue to remain amid a pandemic, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has not skipped a beat in pressing forward with their plan for addressing potentially fraudulent activity associated with COVID 19 billing. 

The current administration has funneled a tremendous amount of money into healthcare systems. It will not be long before they take steps to ensure that the funds were appropriated as intended.​

Waivers, modifiers, lab tests, multiple diagnosis codes…the layers and specifics of COVID-19 coding cannot be overlooked when ensuring appropriate reimbursement and safeguarding claims against third-party payer audits.
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​As hospitals and healthcare organizations begin to assess the required steps necessary to prepare for the transition back to a pre-COVID-19 operating environment, apart from timelines and state and local guidelines, much still needs to be examined to establish stability.

Managing the after-effects of coding and billing as COVID-19 cases start to move through an organization’s billing cycle, while maintaining up-to-date information, could prove challenging.​

​By Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer

As we look to the future, there is hope for positive change to come from the COVID-19 pandemic. The vulnerabilities that are certain to be exposed in our health system from this unprecedented event may help to assist in heightening focus on Social Determinants of Health, (SDoH), to prevent mass spread of disease, unnecessary loss of lives, and ultimately address global health inequities.

BY SUSAN GATEHOUSE, RHIT, CCS, CPC, AHIMA-APPROVED ICD-10/PCS TRAINER ​

BY SUSAN GATEHOUSE, RHIT, CCS, CPC, AHIMA-APPROVED ICD-10/PCS TRAINER ​

The testing phase for the Appropriate Use Criteria (AUC) Program officially began January 1, 2020. Upon implementation of the program, physicians and other healthcare professionals who order an advanced diagnostic imaging test (MRI, CT, PET, and nuclear medicine; does not include X-rays, ultrasounds, or fluoroscopy services) must consult with AUC using a qualified decision support mechanism (CDSM). Professionals who provide these tests will be required to register the ordering professional’s consultation of AUC to be paid for the service. 
 
Providers will be required to use a qualified CDSM (certified as meeting Centers for Medicare & Medicaid Services/CMS requirements). If a provider does not follow AUC requirements and is discovered to have ordering patterns deemed as outliers, the law mandates that CMS require prior authorization. G-codes are needed for every advanced imaging service, and claims with multiple G-codes “shall be’’ accepted.

Unfortunately, the majority of healthcare organizations encounter claim denials on a reasonably regular basis, often, habitually. Though claim denials may be an unavoidable reality in the world of healthcare, ineffective claim denials management can result in even more lost revenue. ​

Axea Solutions is honored to be placed on HealthcareTech Outlooks' robust list of the Top 10 Revenue Cycle Management Solution providers of 2019. ​With decades of expertise developed around coding accuracy and clinical documentation improvement, as well as claims denial management, Axea Solutions is considered to be one of the pioneers in the Revenue Cycle Management arena.