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.
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.
