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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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Examining the Details of the Recent Updates to MS-DRGs

12/7/2020

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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.

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For Audits, Emphasize Preparation, Not Panic

11/18/2020

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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. 

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HHS Provider Relief Fund May Have $25 Billion less than Expected

8/25/2020

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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.

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Patient Options Expand with OPPS Proposed Rule, as 340B Hospitals see Increased Cuts

8/18/2020

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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.

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"The 10 Most Influential Women in Technology 2020" - Axea's CEO Susan Gatehouse

7/17/2020

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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. 

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HHS Issues Requirements for Additional Data and Timely Submission of COVID-19 Testing

6/24/2020

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer ​​
With concerns of COVID-19 having a disproportionate impact on certain individuals, such as minorities and the elderly, public health experts are requiring more detailed data, provided on a real-time basis – further supporting the reliability and integrity of data being central to healthcare.

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Reexamining Internal Compliance Plans as Relaxed Regulations Recede amid COVID-19 Mitigation

6/9/2020

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer ​
While we continue to remain amid a pandemic, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has not skipped a beat in pressing forward with their plan for addressing potentially fraudulent activity associated with COVID 19 billing. 

The current administration has funneled a tremendous amount of money into healthcare systems. It will not be long before they take steps to ensure that the funds were appropriated as intended.​

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Safeguarding COVID-19 Reimbursement

5/20/2020

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer 
Waivers, modifiers, lab tests, multiple diagnosis codes…the layers and specifics of COVID-19 coding cannot be overlooked when ensuring appropriate reimbursement and safeguarding claims against third-party payer audits.
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​As hospitals and healthcare organizations begin to assess the required steps necessary to prepare for the transition back to a pre-COVID-19 operating environment, apart from timelines and state and local guidelines, much still needs to be examined to establish stability.

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State Rollout Plans Already Underway: How to Prepare for After-Effects of Coding and Reimbursement while Managing Continual Updates for COVID-19

4/28/2020

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By Susan Gatehouse, RHIT, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainer
Managing the after-effects of coding and billing as COVID-19 cases start to move through an organization’s billing cycle, while maintaining up-to-date information, could prove challenging.​

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Axea Solutions, Inc. | info@axeasolutions.com | 855.424.4249
  • Services
    • Coding Audits and Reviews
    • Claims and Edit Remediation
    • Denials & Appeals Management
    • RCM Advisory
    • Coder Education and Training
    • Clinical Documentation Improvement
    • Case Studies
  • AXEA ACADEMY
  • AccuTrend
  • About
    • Why Axea Solutions?
    • Leadership
    • Team
    • Careers
    • Axea in Action
  • NEWS
    • News
    • Blog
  • Contact Us
  • Complimentary Webinar