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.
Read previous articles in “Advances in Skin & Wound Care” by Cathy Thomas Hess in the link.
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Cathy Thomas Hess is VP, Chief Clinical Officer for Wound Care at Net Health. She has over 30 years of experience in wound care, authored hundreds of journal articles, spoken at both national and international events, and has authored book chapters and the best-selling handbook titled Product Guide to Skin and Wound Care, 8th edition. She continues to be influential in the wound care community today and serves on the Editorial Advisory Boards for Advances in Skin and Wound Care, authoring a monthly column entitled Practice Points, and Today’s Wound Clinic.