Medical controlling
Provider
Partner for operational and strategic medical controlling
WMC Healthcare acts as an interface between service providers and hospital management.
Current Challenges
A hospital’s billing quality determines the scope of permissible audits by health insurers. A maximum audit rate per hospital limits the extent of audits. Poor billing quality has a negative impact on the provider’s finances. Another key topic right now is structural audits. The MDK Reform Act and other healthcare legislation pose major challenges for hospitals. Without a professional approach to these challenges, revenues that have been firmly budgeted may be lost.
WMC HEALTHCARE takes care of adjustments and realignments to safeguard firmly budgeted revenues
Until a few years ago, hospitals’ structures and equipment were reviewed in many individual cases; since the MDK Reform Act came into force, the process has been consolidated into a structural audit. The result: entire medical service offerings are at risk of being lost, and bills that were incomplete due to missing service documentation can no longer be corrected retrospectively as before. Those who receive negative audit results are not only sanctioned, but will also be audited even more frequently in the future. WMC HEALTHCARE supports this with targeted restructuring in medical controlling to secure hospital revenues.
Our Solutions
We optimize all processes in medical controlling—from patient admission and file flow to discharge management and timely billing, through to implementing the requirements of the audit procedure agreement. This also applies to implementing revenue-relevant structures and medical prerequisites for billing complex treatments.
Clinical documentation deficiencies are no longer a burden with WMC HEALTHCARE by your side.
We analyze them, train all professional groups to ensure proper documentation going forward, and optimize forms and records. When it comes to introducing reporting, we create a hospital-specific reporting system on coding quality and analyze revenue potential at department level. Implementing concurrent coding includes prospective, active case management with length-of-stay management and billing certainty vis-à-vis payers.
To improve revenue management permanently and sustainably, we conduct a potential analysis and then propose suitable measures. These include, for example, coding audits, case discussions on coding recommendations, and support in the audit process for coding recommendations with the Medical Service.
Our services for providers (hospitals)
Select additional topics: