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IV Contrast ─ Healthcare’s Latest Challenge in Supply Chain Shortages

5/12/2022

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By Indya Miller, CCS, Outpatient Compliance Manage Axea Solutions

​Shortages in the supply chain have caused systemic challenges within the engines that support our everyday lives. The newest reported challenge involves supplies of IV contrast. 

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OIG Faults MAOs for Inappropriate Denials

5/3/2022

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer ​
rganizations continue to find the management of denials an Achille’s heel within the revenue cycle.  Insufficient documentation, system flaws, and errors related to human intervention are common reasons for generating a claim denial. 
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG’s) involvement with Medicare Advantage Organizations (MAO) brings heightened awareness and anticipated improvement for the claim payment process and ultimately the patient experience. 

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Barostim Heart Failure Treatment: Proper Procedural and Coding Training Ensure Accurate Reimbursement

4/29/2022

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer ​
In late 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it would begin covering a substantial portion of the cost of implantable heart failure devices for treating chronic heart failure. These devices are designed to treat patients by electrically activating the baroreflex, the body’s natural mechanism for regulating cardiovascular function.
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The initial announcement stated that Medicare would pay for up to 65 percent of the device cost for the next three years. CMS also noted it would cover the device’s implant procedure costs. Thus, any facility performing these procedures today is looking at a significant reimbursement (and potential claim risk, if not properly processed). The 2022 national APC (Ambulatory Payment Classifications) payment rate (Medicare reimbursement under the Outpatient Prospective Payment System, or OPPS) is $30,063.48.

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Payer Strategies and the Long Road to Payment

4/12/2022

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer 
The average cost of debunking a denial is $25 per claim, not to mention the continuous challenges associated with attaining timely payment. Reviewing denial management strategies on a regular basis may prove a more efficient payment journey.
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Claim denials are a continuous challenge for the healthcare industry, as providers struggle with write-offs and the resources needed to manage them. Indeed, a well-thought-out strategy will improve claims’ financial performance; however, as the causes for denials continue to evolve in complexity, the strategy to combat denials should continually be assessed and transformed in order to remain effective. To ensure accurate payment from payers, providers need a strategy that addresses denials with a current, all-encompassing approach.

With a monthly barrage of claim denials, examining the root causes of delayed or non-occurring payment leaves an organization exposed to ongoing denials that could be remediated. 

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Single-Use Endoscopies: An Alternative for Non-Emergent Procedures

2/7/2022

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

An increase in hospital-acquired infections, supply chain challenges, cost containment, and a backlog of some endoscopic procedures have been catalysts for migrating from reusable to single-use endoscopies.
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The global disposable endoscope market size is predicted to reach $2.7 billion by 2025 – an astoundingly large number! Though not all-inclusive, this disposable endoscopic market incorporates bronchoscopy, GI endoscopy, ENT endoscopy, urologic, and arthroscopy. An increase in hospital-acquired infections, supply chain challenges, cost containment, and the backlog of some endoscopic procedures have contributed to migrating from reusable to single-use endoscopies.
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Potential Impacts of new Edit 20 for Inpatient Claims

12/8/2021

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer ​
On Oct. 21, the Centers for Medicare and Medicaid Services (CMS) provided updates to the Medicare Code Editor (MCE), which includes a new edit, R11059CP, for unspecified codes. This edit will directly impact inpatient discharges occurring as of April 1, 2022. 

The list of unspecified diagnosis codes subject to the new edit will require targeted training for your billing staff to avoid reimbursement issues and provide a platform for improving CDI. It is essential to perform a pulse check on the number of unspecified codes currently used in your organization to submit inpatient and long-term care claims. 

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ICD-11 Prep: Examining Prominent Changes in Preparation for the Transition

5/31/2021

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer ​
The transition to ICD-11 will take time – and understanding the new concepts being introduced is a key starting point. Though there is no definite ICD-11 implementation timeline yet established, lessons learned from the ICD-10 transition show that there are numerous steps needed to move toward ICD-11 implementation.

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AXEA's Founder and Chief Executive Officer, Susan Gatehouse, featured in Insightsuccess Magazine: "10 Trailblazing Women in Tech."

4/7/2021

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Insight Success Magazine: "10 Trailblazing Women in Tech"
With concerns of the COVID-19 pandemic having a disproportionate impact on certain individuals, such as minorities and the elderly, public health experts worldwide require more detailed data, provided on a real-time basis. A longstanding proponent of the reliability and integrity of data as central to healthcare, Axea Solutions’ Chief Executive Officer and Founder, Susan Gatehouse, understands such complex elements. 

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Revenue Integrity - Time to Hit the Reset Button

3/19/2021

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer ​
Whether you work for a full-scale enterprise or a smaller healthcare facility, revenue integrity programs' increasing importance is consistent; beyond ensuring accurate billing and collection, these programs should strengthen reimbursement performance and provide sound financial practices.

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Payer Split-Bill Requirement: Separate Claims to Avoid Edit

2/24/2021

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer ​
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Dates associated with Z20.822 and Z20.828 for COVID-19 exposure are critical for billing, as the majority of payers require claims spanning 2020 and 2021 to be split-billed by year. 

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Axea Solutions, Inc. | 1400 Market Place Blvd., Suite 102 | Cumming, GA 30041 | info@axeasolutions.com | 855.424.4249
  • Home
  • Services
    • Coding Audits and Reviews
    • Claims and Edit Remediation
    • Denials & Appeals Management
    • RCM Advisory
    • Coder Education and Training
    • Clinical Documentation Improvement
  • EDUCATION
  • TECHNOLOGY
  • About
    • Why Axea Solutions?
    • Leadership
    • Team
    • Axea in Action
    • Contact Us
  • News
  • Blog
  • Careers