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With all of the external stimuli we confront during day-to-day business operations, it is easy to lose sight of defined objectives. To be effective, we must have a clear purpose. With a clear purpose it is then possible to design sharply focused, results-oriented strategies, objectives and policies. From here, we must stay on track.
For the hospital: The initial strategic elements for compliance is our ability to provide solutions for your clinical and operational concerns related to program/department development, policy and procedures, compliance issues, payment strategies and associated concerns.
For the long-term care facility: The first strategic element for compliance is the ability of WCS to assist your long-term care facility imposed with poor and/or substandard survey results. Through WCS, the action of immediate, time-critical intervention is implemented without delay to bring your facility into prompt compliance. WCS works directly with your facility (on-site, telephonically and through electronic means) to implement the proper assessments, reviews, and on-going auditing/monitoring.
For all healthcare providers: It is important to conduct internal auditing to prevent improper payments. Effective compliance auditing includes proactive monitoring and auditing, which will confirm the provider’s compliance with any legal requirements.
Strategies for Compliance Success
1. Periodic external audits should be conducted as part of your organizational compliance auditing. An outside (third-party) audit would confirm your internal audit findings or provide your establishment with any needed corrective actions should inaccuracies be found. Experts at WCS can perform an external compliance audit of your wound care documentation to identify that your documentation supports your insurance billing and payment.
2. Education becomes a focus for all of your staff. When your entire staff understands the concepts required for the billing and payment of services rendered, it becomes much easier for your organization to meet its compliance standards. WCS will assist your organization in providing education to your wound care department staff.
3. Assessment Tools: WCS has developed assessment audit tools that you can easily utilize to perform compliance auditing. After utilizing these tools, your organization can access and develop any necessary corrective action plans. This will provide your establishment with the necessary documentation to support your billing and payment decisions should you ever be questioned by a medical health insurance provider.
In today’s world of expanded litigation and the possibility of civil and criminal prosecution for misfiling of medical insurance claims, providers should find the need to develop and expand their compliance initiatives. WCS is ready to assist you in meeting all of the strategic elements of compliance.
For assistance Contact WCS.
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