 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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 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.
 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.
 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.
By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer  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.
 By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer As we near the end of what some consider the most unprecedented year in coding, there are more updates to review and decipher in preparation for 2021.
The Centers for Disease Control and Prevention (CDC), under the National Emergencies Act Section 201 and 301, announced further additions to ICD-10-CM classification related to COVID-19. And, CMS has posted new guidelines for ICD-10 CM/PCS coding and an updated MS-DRGs, Version 38.1 ─ all effective Jan. 1, 2021. Updates include new ICD-10-CM and PCS codes for COVID-19.  By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer Recently, the Centers for Medicare & Medicaid Services (CMS) provided a temporary respite on audit activities due to the COVID-19 crisis. This was undoubtedly a welcomed break, as providers were dealing with unplanned layoffs and the furlough of employees, while at the same time, they were required to suspend nonessential procedures. Understandably, however, this respite could not go on forever, and the resumption of audit activity has been expected. ─ Now is the time to prepare, assess provider requirements, and ensure proper compliance is in place.
 By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer Eligible healthcare facilities have begun to recover lost revenue from COVID care for uninsured patients through the U.S. Department of Health and Human Services (HHS) Provider Relief Fund. However, with benefits subject to funding limitations, and the recently proposed removal of an additional $25 billion from the Provider Relief Fund, organizations without efficient processes in place may find themselves at a disadvantage. Implementing swift, proactive remedies may help ensure claims reimbursement while available.
By Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer Released Aug. 4, the Outpatient Prospective Payment System (OPPS) proposed rule for 2021 would eliminate the Medicare inpatient-only list of services while increasing the number of Ambulatory Service Center (ASC)-eligible procedures. The rule would also increase 340B payment cuts, and looks to overhaul the hospital star-rating system.
 Axea's CEO, Susan Gatehouse was featured in a recent article published by Analytics Insight – "The 10 Most Influential Women in Technology 2020".
Analytics Insight celebrates inspiring women leaders, spotlighting forward-thinking women technologists. The piece provides a collection of interviews highlighting some of the most influential women leaders in business today, and their different perspectives on disruptive technologies affecting their industry. |
