With more than 30 years of experience in every facet of the heart of the healthcare revenue cycle, Susan Gatehouse is the epitome of a seasoned expert. She established Axea Solutions in 1999, and as the Executive Officer (CEO), Susan is the driving force behind the company’s success.

​Though she is well known for her strategic leadership in the industry, her authenticity and connection to employees and clients led CIO Women Magazine to choose Susan as one of the most influential women to watch in 2023.​

​The spine is a complex, important part of the body. The slightest ailment can have a dramatic, far-reaching impact. This, along with many other factors, significantly influence coding.  

In the Fall issue of For the Record, a comprehensive article on Coding for Spinal Procedures by Selena Chavis examines various coding challenges and shares tips from coder expert contributions, including some from Wendy Gorrie, an outcome solutions architect with 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. 

Revenue Cycle Management is regarded as the healthcare industry’s backbone, and it is a must for a healthcare provider’s success. A well-rounded Revenue Management Cycle is directly proportionate to a hospital’s profitability, as inefficient handling of the RCM process can directly impact the financial position.

In brief, Revenue Cycle Management Services play a significant role in safeguarding healthcare providers’ financial situation by facilitating the seamless flow of clinical and administrative functions.
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A well-managed Revenue Cycle Management process serves as a link between patients, healthcare providers, and insurance companies. Many RCM firms supply their array of services to healthcare professionals worldwide. This is where ​Axea Solutions stands out as a reliable and trusted firm in the RCM niche.

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.
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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.

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. 

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

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.