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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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Our Culture

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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 (formerly WoundExpert)

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Wound Care

Owning and Auditing Your Wound Care Documentation

November 11, 2019 by Cathy Hess , BSN, RN, CWCN, VP, Chief Clinical Officer for Wound Care

The most critical function of the medical record’s multiple purposes is to plan and provide continuity of care for a patient’s medical treatment. However, in many instances, we as healthcare providers forget that the medical record offers additional provisions including the following:

  • information for financial reimbursement to hospitals, healthcare providers, skilled nursing facilities, and patients;
  • legal documentation in cases of injury or other legal proceedings;
  • information to support quality assurance and peer review committees, state licensing agencies, and state regulatory agencies when assessing the quality of care provided; and
  • critical information for accreditation processes.

The underpinning of wound care documentation must support rules and regulations based on your Medicare carrier and other insurers. The importance of understanding and self-auditing the rules and regulations governing your place of service is paramount. For example, Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). National coverage determinations (NCDs) are made through an evidence-based process with opportunities for public participation. In some cases, CMS’s own research is supplemented by an outside technology assessment and/or consultation with the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC). In the absence of a national coverage policy, an item or service may be covered at the discretion of the Medicare contractors based on a local coverage determination (LCD).

The Medicare Coverage Database (MCD) contains all NCDs and LCDs, local articles, and proposed NCD decisions. The database also includes several other types of National Coverage policy-related documents, such as National Coverage Analyses, Coding Analyses for Labs, MEDCAC proceedings, and Medicare coverage guidance documents.

Local coverage determinations are defined in Section 1869(f)(2)(B) of the Social Security Act (the Act). This section states:

For purposes of this section, the term “local coverage determination” means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an intermediary- or carrier-wide basis under such parts, in accordance with section 1862(a)(1)(A).

Let’s take a look at one LCD and how the utilization guidelines within the LCD establish parameters for typical or expected use of specific services in the outpatient wound care department:



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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