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Outpatient Therapy

Grow Your Rehab Therapy Practice Using Paid Ads and Search Engine Marketing

When done right, paid advertising and search engine marketing are amazing tools to reach new patients and grow your business. By applying several basic tactics, you can start using powerful digital advertising platforms like Google and Facebook to target specific audiences and help ensure a steady flow of business for your practice. Click to View […]

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Hospice

Five Key Stressors Hospice Professionals Face, with Guidance for Support

Hospice professionals help others face death and loss, while juggling interdisciplinary communications, quality compliance regulations and ever-evolving technologies. You are continually there for families and their dear ones who are passing away. But what about you? Get the eBook In caregiving professions, it is easy to get swept up in the needs of others and forget […]

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Leadership

Net Health’s CIO discusses diversity and how it can build a stronger organization

Diversity in the workplace is an on-going issue but it’s an issue with solutions. To build diversity, it takes forward-thinking initiatives, a reexamination of the hiring philosophy, and the support of the company’s decision-makers.  One such supporter of diversity in the workplace is Net Health’s CIO, Jason “JJ” James.  Recent social movements like Black Lives […]

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Tough Questions | Real Answers: Net Health’s Fireside Chat about Race

Net Health did something different recently. Nearly two hundred employees and their families gathered around their computer screens to take part in a landmark event in our company’s history – we called it a “Fireside Chat about Race”.  The purpose of this event was to have a truly open conversation about the controversial but relevant […]

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Industry News Managing Your Wound Care Workflow to Meet Regulations
Wound Care

Managing Your Wound Care Workflow to Meet Regulations

July 8, 2019 by Cathy Hess , BSN, RN, CWCN, VP, Chief Clinical Officer for Wound Care

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.

Download a brochure and learn how Net Health 360 professional services programs conquer the most complex problems in specialized lines of work.


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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Filed Under: Industry News, Wound Care

About the Author

Cathy Hess , BSN, RN, CWCN

VP, Chief Clinical Officer for Wound Care

Cathy oversees clinical and professional services for Net Health. Cathy gained over 25 years of expertise in various acute care, long-term care, sub-acute care facilities, home-health agencies, and outpatient wound care department settings. She is the author of The Clinical Wound Manager™ Manual Series, Clinical Guide to Skin and Wound Care – Seventh Edition (also translated into Italian and Portuguese).


See all posts by Cathy Hess , BSN, RN, CWCN

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