 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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 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.  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.
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.  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.
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.  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.
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.  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.  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.
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