Welcome to 2019! Launching into a new year brings an opportunity to review the work plan created and implemented by you and your team. The underpinning for the work plan must reside in the data collected within the medical record. The medical record demonstrates the clinician’s ability to plan, coordinate, and evaluate patient care. Proper documentation provides guidance for appropriate treatment decisions, evaluation of the healing process, support for reimbursement claims, and a defense for litigation. This information can easily function as a checklist for your team to follow, driving the path for clinical, operational, regulatory, and economic/financial compliance.
Checklists can be created and used as written guides to help your team meet key steps in compliance. In wound care, clinical, operational, regulatory, and economic/financial rules help maintain compliance with standards, and checklists can provide an audit tool to ensure that requirements have been followed. Using a clinical checklist can help to better organize the clinician’s time.
Consider the following clinical and operational checklist:
- Use an interoperable, specialty wound care electronic health record.
- Create and streamline smart, strategic workflows for staff and providers.
- Integrate evidence-based medicine and wound care pathways.
- Manage the department through a comprehensive reporting engine providing clinical, operational, financial, and marketing reports.
- Update patient-specific education.
- Review and update the product formulary and technologies.
- Know hospital accreditation standards and support within department and documentation workflows.
- Implement Clinical Decision Support Alerts.
- Review and update your department’s clinical and operational policies and procedures, including signature requirements for your documentation process.
- Review and update job descriptions.
- Ensure staff credentials and competencies and skill sets are up to date.
- Review budget for staff education.
- Reevaluate the use of technology and supplies to ensure appropriate use for your patient population.
- Coordinate discussions with clinical providers to ensure appropriate understanding of surgical wound care services and documentation requirements.
- Manage patient outliers and update plans of care.
- Review and update payer matrix.
- Map authorizations and verification of benefits, advance beneficiary notice, and copay processes.
- Ensure the “reason for referral” is clearly documented.
- Understand insurance verification and medical necessity by payer process.
- Review the annual Office of Inspector General work plan to improve operations, clinical documentation, and charging and coding practices.
- Implement and review the wound care department’s charge description master, Current Procedural Terminology 4,* and Healthcare Common Procedure Coding System level II with modifiers (if appropriate).
- Meet with select departments to review updates for preregistration, coding, billing, medical records, and denial management.
- Implement interfaces to capture and send codified data, which decreases duplicative work and improves patient safety.
- Mentor staff.
- Participate in the 2019 Quality Payment Program1
Read previous articles in “Advances in Skin & Wound Care” by Cathy Thomas Hess in the link.
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Cathy is Chief Clinical Officer for WoundExpert® and Vice President at Net Health, and in addition to being the MIPS Clinical Consultant for WoundExpert. She gained over 30 years of expertise in various acute care, long-term care, sub-acute care facilities, home-health agencies, and outpatient wound care department settings. Cathy is the author of Clinical Guide to Skin and Wound Care (also translated into Italian and Portuguese) – Eighth Edition published in September of 2018.