Wound Care Stakeholders’ Insights: Revenue Management Cycle

To receive an invitation to serve as the guest editor of this journal is truly an honor, for which I thank HMP, Joe Darrah, and Dr. Caroline Fife. I was particularly excited when I learned that this special reimbursement-focused edition of Today’s Wound Clinic (TWC) would be shared with attendees of SAWC Fall 2018 in addition to our loyal subscribers. Because I know that wound care professionals enjoy hearing real-life information from their peers, I decided to fill this issue with reimbursement insights from wound care stakeholders throughout the revenue management cycle. Therefore, you will see the term “insights” as a recurring theme throughout this publication. As part of the research that went into this edition of the journal, we solicited input on a variety of topics and were grateful that many wound care stakeholders took the time to share so much valuable information. What follows is just a glimpse of what you will be able to find in the journal that you now hold in your hands or are scrolling through online.

Documentation is key to receiving appropriate payment and keeping that payment after an audit. In the article “Coder’s Insight: Documentation Elements & Audit Resource Guide for CTPs” by my fellow TWC editorial advisory board member Donna Cartwright, MPA, RHIA, CCS, RAC, FAHIM, readers will learn how to determine if documentation is required for this procedure and how to conduct self-audits. A special thanks to Donna for authoring this article and for creating a sample audit guide that wound care stakeholders can use when conducting self-audits pertaining to documentation for application of cellular and/or tissue-based products (CTPs) for skin wounds. The article “Wound Care & Hyperbaric Insights: Revenue Cycle Tips for New Wound Care Clinics” should be very interesting to all readers. Those who are presently opening a wound care business (or are planning to do so) will benefit from various tips that their peers would surely have liked access to at the time they opened their respective businesses. For those who already manage existing wound care businesses, this content will likewise prove useful as you refine your revenue-management process ongoing.

MANAGEMENT MUSINGS

At one time or another, hospital executives are faced with an important question: Should we manage our hospital outpatient wound care provider-based department (PBD), or should we hire a wound management company? We invited a multitude of wound care management company representatives to share an overview of their reimbursement services with our readers. The article “Management Company Insights: Reimbursement-Related Services” provides responses from those companies’ officials who chose to share their information. The overview should prove very helpful to those considering partnering with management companies. The article “Physician Practice Management Insights: Revenue Cycle Tips When Beginning Your Wound Care Practice” educates wound care physicians and other qualified healthcare professionals (QHPs) on the fine points of professional wound care practice management. In fact, I feel quite certain that physicians and QHPs will learn several revenue cycle tips that they have never considered. The related article “Wound Care Physician Insights: Changing Compensation Models” by yours truly shares a variety of ways wound care physicians throughout the United States are paid in volume-driven healthcare systems and how physicians who were interviewed for the piece expect their compensation models to change as their healthcare systems become more value-driven. Physicians and other QHPs should consider this article a “heads up” to start thinking about how they should refine their wound care businesses to focus on quality, value, and increased patient satisfaction. Additionally, in my Business Briefs column, I share issues that are routinely presented to reimbursement strategy consultants. This article should be of interest to wound care professionals of all varieties who produce, distribute, and use new wound care devices.

In response to reader requests for more real-life reimbursement scenarios, TWC has also invited me to launch a new column that appears for the first time in this edition of the journal and will be published periodically moving forward. If you have a reimbursement topic that you would like featured in Consultation Corner, please send an e-mail to kathleendschaum@bellsouth.net. I hope you enjoy this first real-life consultation that I have handled for many hospital outpatient wound care PBDs over the past 12 months. I also hope that you enjoy this special reimbursement edition of TWC as much as I have enjoyed working with all of the contributors and authors who were so willing to share their information. I look forward to seeing you all in Las Vegas for SAWC Fall 2018!