{Straight talk for clients}
Manually tracking policy procedure rules? WoundExpert now has a better way. Learn more about the new Procedure Tracking Tool.
December 2017
Dear WoundExpert,
I heard through the grapevine that certain geographic areas are recommending monitoring the number of specific procedures that are billed for Medicare patients within a specified timeframe. What are these guidelines and what should I do about them?
The Scenario
If you treat Medicare patients, your facility works with Medicare Administrative Contracts (MACs), private health care insurers who are responsible for administering Medicare claims. These multi-state and regional MACs publish policies called ‘Local Coverage Determinations’ (LCDs) that may affect you based on their jurisdiction and your geographical location. Some LCDs request that care providers monitor the number of procedures that are being done for patients based on appropriate medical necessity.
To learn more about LCD policies that could impact you, click here.
Let’s look at an example. A new policy from early November affects patients covered by two MAC carriers, Novitas and First Coast. After conferring with your billing department for interpretation (always the best first step!), you determine that only 8 surgical debridements should be performed for a single patient within a 360-day period. This means you’re responsible for keeping tabs on how many of those procedures have been done per patient. If you were to perform more than 8 surgical debridements during that time, the carrier could request documentation to support medical necessity.
The Solution
WoundExpert can help you track and monitor your procedure counts!
The new Procedure Tracking Tool gives facility administrators the ability to set up rules to track procedures submitted on the Superbill and begin tracking the number of those procedures performed within a specified timeframe based on the patient’s insurance.
So, for example, using the policy outlined above, once a surgical debridement for a Medicare patient is documented (e.g. code 11042 is submitted on the Superbill), you’ll begin to see tracking information appear on the Patient Visit Panel, the Superbill, the Procedure page, as well as the Schedule Visit page. Use the Procedure Tracking Report to quickly check on the status of all patients at a facility and their progress towards Procedure Tracking rules that have been configured.
Users Like You
WoundExpert users are finding great value in the Procedure Tracking Tool. Valerie S., Director of Wound Care at Fountain Valley Regional Hospital, has this to say about the Procedure Tracking Tool: “Under our hospital Local Coverage Determinations (LCDs) our department needs to track that the appropriate usage of excisional debridements, wound vacs, and Skin Subs are met. The Procedure Tracking Tool is a one stop shop that allows me to see everything that I need to make informative decisions about the care that the patients are receiving. The Procedure Tracking Tool allows us the ability to see firsthand any procedure we want to track. It is a necessary tool to that helps us when our LCD places limits on specific procedures.”
For more information on how these rules are set up and tracked including a video demo, visit the Billing and Services Forms section of the How-To Documentation in WoundExpert and select the Procedure Tracking and Alerts topic or search for ‘Procedure Tracking and Alerts Admin.’
WoundExpert Experts
This month’s contributor was Sheila Cougras, Director of Compliance
Connections Corner
Check out the most recent order form enhancements!
This month, McKesson Patient Care Solutions (WPS) and Acelity/KCI (NPWT) have made significant updates to their order forms. Access each form through their respective modules in the Connections page to review these changes.
Easily review your facility’s Connections orders with the Connections Status Report.
Did you know that users with access to WoundExpert reports can easily view a comprehensive list of all Connections orders that have been submitted from their facility via the Connections Status Report? To access this report, first click on the Reports button on the left-hand side of the WoundExpert interface and then select Connections Status Report from the Operations dropdown menu.
Brought to you by Michael Ashbaugh, Account Manager
Did you know?
While all 50 states (and DC) now permit electronic prescribing of controlled substances (EPCS), state mandates for utilization of this functionality continue to expand. Currently, New York, Maine, and Minnesota require the use of EPCS (only opiates in Maine), while Connecticut recently announced their requirement will go into effect as of January 1, 2018. North Carolina, Virginia, and Rhode Island have also set future deadlines in 2020, and additional states have legislation pending. Click here for an interactive map of the current state of EPCS mandates across the country.
WoundExpert makes EPCS simple through a partnership with DrFirst’s EPCS GoldSM solution. With 90% of pharmacies nationwide readily accepting EPCS, providers in all states can take advantage of EPCS for paperless prescribing. In conjunction with state-run prescription monitoring tools, EPCS helps to safeguard responsible prescribing practices that can help fight the opioid epidemic. Additionally, providers who already e-prescribe can save time by using a single workflow for both controlled substances and legend drug prescriptions. To learn more, contact info@nethealth.com.
