March 18, 2024 | Net Health

8 min read

A Beginner’s Guide to Starting a Wound Care Private Practice

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Wound Care in Clinics, Homes, and Facilities Is Expanding

Talk to a wound expert throughout the profession, and you’ll hear of more clinicians choosing to go out on their own as independent wound care experts. One of the biggest trends for healthcare professionals in the post- pandemic marketplace has been a recognition that there are alternatives to traditional employment with hospitals, clinics or physician practices.

This epiphany is spreading quickly among providers, like physicians and advanced practitioners, who want to get back to hands-on patient care, the reason they entered the profession in the first place.

Whether provided in clinics or skilled nursing facility settings or by providers who make house calls (e.g., traveling) — is well-suited to new approaches to employment. Hard data is scarce, but talk to people in the profession, and you’ll hear of more clinicians choosing to go out on their own as independent wound care providers. It’s a tremendous opportunity to be your own boss, put destiny in your own hands, and do what you love most: helping patients.

To succeed, however, you’ll need to take off your clinician hat and put on a business one from time to time. There’s a lot to consider when starting your private practice, including:

  • Finding the right electronic health record (EHR) system
  • Coding, billing and reimbursement
  • Compliance and documentation
  • Marketing, referrals and growing your business

A good EHR for your successful private practice wound business will be essential. Vendors who partner with you on your journey are also crucial. As you start or consider this exciting journey, here are five essential areas to explore and implement. Best of luck!

Finding the right EHR for wound experts

Many providers are guided through their documentation process when working in a hospital or clinic setting– use this code, put it in the chart, fill out this report, etc. You often know the “what,” but not the “why.” As a new small business owner, you need to understand the “why.”

Your EHR should have the ability to provide you with those vital insights. It will become the foundation for everything you do and impact documentation, coding, billing, and even your marketing. Best of all, a good EHR can focus on the business side, while you can pay attention to patient care and growing your business.

Because your EHR will be crucial to your practice, look for a partner that provides optimal value and personalized attention. Try to avoid systems that will need complicated interfaces and workarounds with other features, such as mobile imaging. You don’t want a duct tape solution that will take time to build and be subject to more problems. To ensure your success, ask these questions:

  • What’s the track record for the EHR? Is it widely used?
  • Can I speak to current users?
  • Is the EHR-certified?
  • Does the EHR offer a billing solution?

What kind of support can I get?

Talking with people who’ve been there and done that is invaluable for a new practice. Net Health provides a team of experts helping clinicians like you build out their private practice for years. Additionally, for physicians traveling into post-acute facilities, look for a specialty EHR that can support integration with the major post-acute EHRs.

Benefits of the right EHR for your wound expert practice

  • Ensure accurate documentation
  • Built for wound care to streamline coding and billing
  • Drive data to and from patient records
  • Eliminate redundant data entry
  • Reduce the chance of errors
  • Save time
  • Optimize revenue
  • Grow a successful business!

What is a certified EHR?

According to CMS: In order to efficiently capture and share patient data, health care providers need certified electronic health record (EHR) technology (CEHRT) that stores data in a structured format. Structured data allows health care providers to easily retrieve and transfer patient information and use the HER in ways that can aid patient care. CMS and the Office of the National Coordinator for Health Information Technology (ONC) have established standards and other criteria for structured data that EHRs must meet to qualify for use in the Medicare Promoting Interoperability Program.

Picture the ideal imaging tools

Mobile apps allow you to grab images of wounds and track progress over time wherever you – or the patient – may be. Apps like Tissue Analytics now incorporate predictive technologies to help better identify non-healing wounds early. Digital technology is a real benefit to private practice. And most importantly, it will save you several hours a day. However, be sure the platform you work on integrates – as in it seamlessly downloads images – with your EHR. That’s key, as the images will drive coding, billing and many other critical functions. With an integrated imaging vendor and an EHR built to support wound care documentation, including procedure coding automation support, you’ll have a clear record of every step you took during each visit.

Focus on spot-on billing

Speaking of billing . . . that is understandably critical to your new venture. Accurate documentation and coding are vital to driving the claims process and putting everything that was done for a patient into the SuperBill. And as a busy provider, you want a system that makes these steps simple, not complicated.

EHRs that provide features that ensure coding accuracy and reduce manual input of data offer tremendous value to your new practice. You don’t want to spend your evenings following a busy day at work inputting data for billing; you want that to happen as you conduct your procedures. There is a range of services you provide that can be billed, including:

  • Treatment and assessment of chronic wounds from chronic diseases such as obesity and diabetes that prevent healing can be covered under accurate wound care medical billing and coding.
  • Other wound care treatments, including procedures debridements.

Wound care billing is complex, plus there are multiple regulations to follow. Simple errors in CPT coding can be costly. CMS has pages of guidelines for billing, which can be overwhelming. Consider just some of the guidelines and rules –Net Health keeps up with the latest International Classification of Diseases (ICD- 10-CM/PCS) standards, including updating the code changes each October via direct file uploads from CMS/ WHO. Accurate ICD-10-CM code selection is required to meet medical necessity and carrier policy requirements, which are necessary for reimbursement.

There’s a lot to learn – and do – but the right technology and partner can help, so be sure to select resources that will help you with this critical step.

Incorporate analytics for clinical and operational tasks

Finding ways to run a competitive, quality-centered practice involves many factors, and your focus needs to be on both clinical and operational issues. We’ve talked about how technology can help new practices; emerging innovations that involve analytics can also play a significant role in your success.

It helps to have a scalable suite – one that grows as you do – of predictive analytics models that will assist with evaluating, treating, and managing patient relationships. On the operations side, some of the more important tasks you’ll undertake are MIPS documentation and other value-based payment programs and reporting. For example, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a Quality Payment Program for Medicare that replaced the Sustainable Growth Rate formula. MACRA offers two tracks: MIPS (Merit-Based Incentive Payment System) or APM (Alternative Payment Model).

Most private practice, and traveling wound experts, utilize the MIPS track, which is most applicable to the wound care market. To learn more about: the MIPS track, click here to visit the CMS website. Another important feature for those in outpatient private practice is a comprehensive suite of patient engagement resources. For example, combining digital marketing tools with personalized patient communications can attract and retain more patients.

Document, document, document!

After providing excellent care to your patients, arguably the next most important step you can take in a wound care practice is documentation. Looking for an EHR and software partner that offers an adaptive user experience that supports custom workflows and intuitively guides you through optimal and compliant documentation is vital in today’s marketplace.

Are you worried about compliance? That is understandable. It’s important. Ensure the software you select is tailored for wound experts and doesn’t just generically monitor regulatory changes. Look for a platform that pays special attention to anything that affects your medical record and coding needs.

CMS is constantly updating regulations. Be sure to monitor for changes that can impact what you do. (Note that Net Health pays special attention to these changes and provides continuous updates to our clients’ EHR systems. Additionally, we offer personalized consultative services if needed.)

About interoperability…

Your EHR and software solutions need to be able to integrate with the healthcare systems used today, including:

  • ePrescribing via Surescripts and EPCS workflows
  • Direct messaging and C-CDA reconciliation and incorporation
  • Claims and ERA submissions via Clearinghouses
  • Other EHRs via HL7 or API (the set of standards for the transfer of clinical data)

And you need to have the ability to support FHIR® (Fast Healthcare Interoperability Resources). These tools are becoming the standard for best practices in healthcare technology today but are often missed by non-certified EHRs.

Keeping track of additional ongoing regulations and changes, such as the Outpatient Prospective Payment System (OPPS) and Medicare Physician Fee Schedule (MPFS), can feel overwhelming when you are also trying to treat patients and run an efficient wound clinic. We’ve got you in mind. For example, Net Health’s Product Compliance Team works tirelessly to monitor these programs and provide updates to Net Health Wound Care to help support your practice’s compliance with existing and ever-changing regulatory requirements that affect your EHR and related technologies. If you have or plan to start a new wound care private practice, whether traveling or outpatient, you are in for an exciting and rewarding adventure. There are many steps to take and important issues to consider. However, when you pick the right technologies and partners, your new venture has the pieces in place to be a success.

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