March 18, 2024 | Net Health

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Net Health CORE Workflow Checklist

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Apply our CORE (Clinical, Operational, Regulatory, and Economic) methodology designed to help streamline workflow

As you reflect on the areas of your wound care practice, think about these starter questions — they will help inform your choices along the way:

  • What is the “why” behind your workflow?
  • How are your workflows constructed and what are the dependencies?
  • When do you update your workflows?
  • What features have you implemented this year to update your workflows?

Clinical

  • Update evidence-based medicine and wound care pathways.
  • Integrate innovative tech like digital imaging and predictive analytics.
  • Ensure clinical wound documentation, diagnosis, and codes reported meet medical necessity.
  • Refresh patient-specific education based on the patient population served.
  • Review and update the product formulary and technologies.
  • Install clinical decision-support alerts. Manage patient outliers and update plans of care.
  • Educate all providers so they better understand surgical wound care services and documentation requirements.

Operational

  • Review and update your department’s clinical and operational policies and procedures, including signature requirements for your documentation process.
  • Map authorizations and verification of benefits, advance beneficiary notices and copay processes.
  • Ensure the “reason for referral” is clearly documented.
  • Understand insurance verification and medical necessity by payer process.
  • 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.

Regulatory

  • Review managed care and payer agreements and limitations.
  • Reduce the risk of audits — review the annual Office of Inspector General work plan to improve operations, clinical wound care documentation, and charging and coding practices.
  • Review medical necessity and compliance guidelines that can be payer-specific.
  • Confirm revenue cycle management processes that include patient registration, compliant billing, and denial management.
  • Ensure coding and billing personnel are familiar with the wound care process.
  • Encourage educational updates for clinical, coding, and billing personnel.

NOTE: This checklist is not meant to be exhaustive. It remains your responsibility to review your CORE processes to
determine which checklist items are appropriate for your practice.

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