March 18, 2024 | Net Health

2 min read

Net Health CORE Workflow Checklist

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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