​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.

Axea Solution's CEO, Susan Gatehouse was recently interviewed in a segment for public television on the future of technology and AI in healthcare. Discussing the importance of accurate, actionable data and how it relates to the digital transformation happening in the world of healthcare, Susan shared her insight on the possibilities of the possibilities of these advancements.

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

Are Social Determinants of Health the Future of Value-Based Care? 
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In the shift to Value-Based Care Models, Social Determinants of Health (SDoH) are becoming more of a driver. Economic stability, social and community context, neighborhood and environment, and education all play a part in a patient's overall ability to maintain their health. This is precisely why the healthcare industry is seeing an increased focus on SDoH.

Data for clinical and business intelligence can be the catalyst to uncovering opportunities within clinical documentation improvements, leading to valuable transformational changes in processes. 

In part II of Susan Gatehouses' article in ICD10Monitor News, Susan expands on how to create a transformational environment, and examines the current state of clinical documentation improvement (CDI), and how implementing feedback and developing connectivity can directly affect operational improvement and quality of care.