Last updated on 7/18/21 | First published on 2/26/18 | Literature review current through Feb. 2023
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Authors:
Jeff Mize RRT, CHT, UHMSADS,
Tiffany Hamm BSN, RN, CWS, ACHRN, UHMSADS,
more...
Coauthor(s)
Jeff Mize, RRT, CHT, UHMSADS
Disclosures: Nothing to disclose
Tiffany Hamm, BSN, RN, CWS, ACHRN, UHMSADS
Chief Nursing Officer, Wound Reference, IncDisclosures: Nothing to disclose
Editors
WHY USE HBO AND WOUND CARE CONSULTING SERVICES?
Wound Care and Hyperbaric Medicine consulting services are a collaborative effort between both parties in the development, coordination and operation of wound care and hyperbaric services. Wound Care and Hyperbaric consulting companies (e.g., MidWest Hyperbarics, LLC) provide value by utilizing their experience and expertise when guiding client partners with essential steps in designing and building a compliant wound care program. That guidance is determined by their client partner’s vision and preferred operating model.
When evaluating and deciding on the appropriate model, it is useful to identify and define what outcome is desired to determine success. Does the service focus on hyperbaric oxygen therapy, wound care or both? Practice experience would suggest that “it is possible to operate a successful cost neutral wound care program without hyperbaric services, but it is extremely difficult to operate and maintain a successful hyperbaric service without an associated wound care program”. As well, successful hyperbaric medicine programs depend on referrals from both outpatient and inpatient wound care services.
Successful Wound Care and Hyperbaric Programs are integrated, cohesive and function cooperatively to deliver optimal patient care. This is achieved through education of internal healthcare professionals, the medical community and support staff.
Consultants are typically utilized in:
- Development and start-up of a new program
- Provide support to a Wound Care Program adding Hyperbaric Oxygen Therapy
- Transition away from a program previously operated by a management company
- Existing Wound Care and Hyperbaric Medicine program support
- Chart Auditing for Medical Necessity
TYPES OF ENGAGEMENT
New Facility Start-up Services or the addition of Hyperbaric Oxygen Therapy
Consultants will assist the Institution by providing guidance and operational support for the development of wound care and hyperbaric medicine services. The consultant provides oversight throughout development and the initiation of daily operations to ensure implementation and adherence to policies and procedures. A consultant functions as a contributing member of the program development team by participating in management decisions that impact the Wound Care and Hyperbaric Service.
Management Transition Services
Assistance with transition from a management controlled program to an in-house, facility operated, service is highly recommended. This systematic process begins prior to notifying the management company of the termination of the existing contract. A consultant functions as a contributing member of the Transition Team by participating in management decisions that impact the Wound Care and Hyperbaric Service.
Existing Program Support Services
Consultants utilize their expertise and experience to ensure that the existing program meets regulatory compliance requirements and functions at the highest level of industry standard. This should be a systematic analysis of areas identified as critical components to the safe, appropriate, and effective operation of the wound care and hyperbaric facility. The consultant should function as a contributing member of the Wound Care and Hyperbaric Medicine Team by participating in management decisions.
Medical billing and reimbursement is the portion of the hyperbaric medicine service that will either improve or obstruct the revenue of your program. The coding and billing for hyperbaric oxygen therapy is a process that has been scrutinized in recent years by the Office of Inspector General (OIG). This information is provided to illustrate the diligence that must be given to hyperbaric billing and reimbursement. Consulting services are an invaluable resource with with coding, daily charge control, claims submission, as well as appeals process support.
Utilization of consultants is a cost-effective resource. Ideally, the consulting service should be cognizant of the budgetary and fiscal challenges healthcare facilities withstand while continuously monitoring Undersea and Hyperbaric Medical Society activities as well as CMS regulatory directives pertaining to wound care and hyperbaric oxygen therapy to ensure that program operations are compliant. To that point, consulting service options should be designed to meet the individual fiscal needs, contractual length (terms) and operational needs of the client partner.
Consultative service(s) should be capable of providing the following
- Facility Design and Development Support
- Hyperbaric Operational Policies
- Hyperbaric Medicine Operational Procedures
- Annual Hyperbaric Service policy updates
- Hyperbaric Medicine Treatment Protocols
- Annual Hyperbaric Medicine Protocol updates
- Documentation and Proprietary Documents
- Emergency Procedures
- Midwest Hyperbaric Website – online content
- Procurement of equipment – required equipment list
- Education – Primary Hyperbaric Training
- Staff Competency Evaluation – Hyperbaric Medicine
- Staff Competency Evaluation – Wound Care
- Facility Compliance Evaluation
- Clinical Staff Orientation – Hyperbaric Medicine
- Clinical Staff Orientation – Wound Care
- Hyperbaric Preceptorship
- Hyperbaric Staff Job Descriptions
- Wound Care Staff Job Descriptions
- Safety Program Development and Implementation
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- Prohibited Items Authorization – documentation
- Safety Director support – 24/7
- Nurse Manager or Program Director Support – 24/7
- Medical Director Support
- Medical Staff Credentialing guidelines
- Physician Preceptorship
- Clinical Operation Development
- Monthly Safety discussion
- Monthly Compliance discussion
- Scheduling and Work-flow guidance
- Mentoring of the wound care and hyperbaric staff.
- Billing and Reimbursement Support
- Pre-determination review of HBOT candidates
- Assistance with claims adjudication
- Hyperbaric Medicine QA/PI program
- Wound Care QA/ PI program
- Program evaluation
- Accreditation Preparation
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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.