Medical Controlling
Provider
Partner for operational and strategic medical controlling
WMC Healthcare acts as an interface between service providers and clinic management.
Current Challenges
The billing quality of a clinic determines the extent of permissible audits by health insurance companies. A maximum audit quota per hospital limits the scope of audits. Poor billing quality negatively affects the provider’s finances. Another key phrase of the moment is: structural audit. The MDK Reform Act and other healthcare laws pose major challenges for clinics. Without professional handling of these challenges, firmly calculated revenues could be lost.
WMC HEALTHCARE takes care of adjustments and realignments to secure firmly planned revenues
While until a few years ago, structures and equipment of clinics were examined in many individual cases, the procedure has been bundled within the framework of a structural audit since the MDK Reform Act came into force. The consequence: Complete medical service offerings are at risk of being lost, and invoices that were incomplete – due to missing documentation of services – can no longer be corrected retrospectively as before. Those who achieve negative results in the audit will not only be sanctioned but will also be audited more frequently in the future. WMC HEALTHCARE provides support here with targeted restructuring in medical controlling to secure clinic revenues.
Our Solutions
We optimize all processes in medical controlling, from patient admission through file routing, discharge management and timely billing, to the implementation of the audit procedure agreement requirements. When it comes to introducing new procedures – for example, the so-called Patient Blood Management – we professionally accompany these and stand by as valuable advisors. This also applies to the implementation of revenue-relevant structures and medical prerequisites for billing complex treatments.
Clinical documentation deficiencies are no longer burdensome with WMC HEALTHCARE by your side.
We analyze these, train all professional groups for proper documentation in the future, and optimize forms and files. When it comes to introducing reporting, we create hospital-specific reporting on coding quality and analyze revenue potentials at the department level. Our implementation of case-accompanying coding includes prospective, active case management with length-of-stay management and billing security vis-à-vis cost bearers.
To improve revenue management permanently and sustainably, we conduct a potential analysis and subsequently propose suitable measures. These include, for example, coding revisions, case discussions on coding proposals, and support in the audit process for coding proposals by the Medical Service.
Our Services for Providers (Hospitals)
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