Regulatory Compliance

Worried about compliance? Since WoundExpert powered by xfit is perfectly fitted for wound care, we don’t just generically monitor regulatory changes. Instead, we watch with a keen eye towards anything that affects your medical record and coding needs. Learn about the regulatory changes that Net Health stays ahead of to help keep clients in the know and support compliance needs.  

MACRA: Supporting the MIPS Track

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a Quality Payment Program for Medicare that replaced the Sustainable Growth Rate formula. MACRA offers two tracks: MIPS (Merit-Based Incentive Payment System) or APM (Alternative Payment Model). WoundExpert supports the MIPS track which is most applicable to the wound care market. Required participants who choose not to submit any 2020 data may receive a -9% (maximum penalty) payment adjustment in 2022.

Four components make up the MIPS model:

• Quality
• Promoting Interoperability
  - to obtain WoundExpert’s 2015 Edition certification information click here)
• Improvement Activities (a category that rewards clinicians for care focused on care coordination, beneficiary engagement, and patient safety)
• Cost (replacing Value Based-Payment Modifier)

To learn more about:

• the MIPS track, click here to visit the CMS website.
• how WoundExpert powered by xfit specifically supports MIPS, contact us at info@nethealth.com or 800-411-6281 Option 3.
• improving your clinical and operational workflows to support MIPS reporting, discover our 360 Professional Services with Cathy Thomas Hess by contacting info@Nethealth.com or 800-411-6281 Option 3.

ICD-10-CM

Net Health keeps up with the latest ICD standards, including updating the code changes each October via direct file uploads from CMS/ WHO. Accurate ICD-10-CM code selection is required to meet medical necessity and carrier policy requirements, which are necessary for reimbursement.

Documentation Coding Reconciliation Features

Physician Evaluation and Management (E&M) Tool

WoundExpert directly utilizes the provider’s documentation and aligns the E&M level based on the 1997 Documentation Guidelines for Evaluation and Management Services. This can be especially helpful with ensuring the provider’s documentation supports the appropriate E&M levels for coding and reimbursement. As CMS kicks off its new initiative Patients Over Paperwork, Net Health is closely monitoring this update beginning in CY 2021.

The Joint Commission

The Joint Commission standards “focus on important patient, individual, or resident care and organization functions that are essential to providing safe, high-quality care.”¹ We understand that complying with The Joint Commission Standards is important to our clients. That’s why WoundExpert provides the tools and necessary documentation elements to comply with the requirements set forth by The Joint Commission.

Electronic Prescribing of Controlled Substances (EPCS)

Through a partnership with DrFirst’s EPCS Gold^SM solution, WoundExpert follows the regulations set by the Drug Enforcement Administration to allow for practitioners to electronically write prescriptions for controlled substances. The use of electronic prescribing for controlled substances (EPCS) is both legal and widely used in all states and is mandated in some states. Providers who already e-prescribe save time by using a consistent e-prescribing workflow for both controlled and non-controlled drug prescriptions. Click here for an interactive map of the current state of EPCS mandates across the country.

Monitoring of Final Rules/Laws (Federal Register)

Keeping track of additional ongoing regulations and changes such as Outpatient Prospective Payment System (OPPS) and Medicare Physician Fee Schedule (MPFS) can feel overwhelming when you are also trying to treat patients and run an efficient wound clinic. We’ve got you in mind. Our Product Compliance Team works tirelessly to monitor these programs and provide updates to WoundExpert to help support your clinic’s compliance with existing and ever-changing regulatory requirements that affect your EMR.

¹ Facts about Joint Commission standards. (2016, March 25). Retrieved January 24, 2017, from www.jointcommission.org/facts_about_joint_commission_accreditation_standards/