July 8, 2019 | Cathy Thomas Hess, BSN, RN, CWCN

2 min read

Managing Your Wound Care Workflow to Meet Regulations

Proper workflows are at the heart of a successful wound care business. Whether you are in the outpatient wound care setting or working as a traveling physician, designing clinical and operational workflows requires close review and customization of current clinical and documentation practices for an efficient outcome. Current practices include the operational processes for registration, coding, billing, medical records, and denial management, as well as cognitive workflow by clinicians. Each of these workflows should map to the documentation elements within your electronic health record. Producing the right combination of operational oversight and clinical experience with the underpinning of a solid documentation system will produce efficient business practices and optimal patient flow and care.

Understanding Your Regulations

Each clinical staff member must understand the rules and regulations that guide wound care documentation and billing processes. The rules within the wound care department are generated from your fiscal intermediary, carriers, Medicare Administrative Contractors, National Coverage Determination, respective Local Coverage Decisions (LCDs), the Centers for Medicare & Medicaid Services, The Joint Commission, American Medical Association, Merit-based Incentive Payment System (MIPS), and so on. With so many rules and regulations governing your work and documentation, it is important to have processes in place to ensure your workflows and documentation support the rules.

Understanding Your MIPS Workflow

Let’s take a look at mapping MIPS into your workflow, focusing on the MIPS clinical quality measures (https://qpp.cms.gov/mips/quality-measures). This calendar year, participants collect measure data for the 12-month performance period (January 1 to December 31, 2019). The amount of data that must be submitted depends on the collection (measure) type.

For electronic Clinical Quality Measures, MIPS Clinical Quality Measures (formerly “Registry Measures”), Qualified Clinical Data Registry Measures, and Medicare Part B claims measures (only available to small practices):

  • Participants should submit collected data for at least six measures or a complete specialty measure set; and
  • One of these measures should be an outcome measure. If you have no applicable outcome measure, you can submit another high-priority measure instead.
  • In addition, for groups of 16 or more clinicians who meet the minimum of 200 cases, the administrative claims-based all-cause readmission measure will be scored as a seventh measure automatically.

To read the full article in “Advances in Skin & Wound Care” by Cathy Thomas Hess, click here.

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.

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