Top 5 Questions Regarding Outpatient Reimbursement for Wound Care

1
(No Transcript)
2
Top 5 Questions Regarding Outpatient
Reimbursement for Wound Care
Do outpatient reimbursement for Wound Care
challenges frustrate you a lot? Medicare
reimbursement regulations that are currently
impacting wound care practices. Wound care
professionals still have to follow the coding,
payment, and coverage regulations for submitting
claims to traditional Medicare. Issues in
Outpatient Reimbursement for Wound Care Q. 1
Why it is crucial to know whether the outpatient
wound clinic is a hospital-based outpatient wound
care department or just a wound clinic?   When
patients are examined in a hospital-based
outpatient wound care clinic they receive 2 bills
i.e. one from HOPD and another from QHP. Hence
the patients are seen by a QHP in his or her
office, the patients and Medicare only receive
one bill. Patients should be informed about
whether they should expect one or two bills.
3
Top 5 Questions Regarding Outpatient
Reimbursement for Wound Care

• Q. 2 Theres always coding confusion and
  diagnoses typically need to be updated how to
  do that?
•  
• Codes for products, procedures/services, and
  diagnoses are typically updated on an annual
  basis, although some codes for drugs/biologics
  and coding edits (see below) may be modified on a
  quarterly basis. Two major coding regulations are
  impacting the wound care industry and deserve
  special attention from wound care professionals
• Define patients clinical status and treat their
  complex medical conditions
• Coordinate care among providers, and support new
  payment methods that drive quality of care
•  
• Q. 3 If an LCD is not written about a particular
  service, procedure, or product, Medicare does not
  cover it?
•  
• No, it doesnt. If a MAC has not released an LCD,
  it means the Medicare administrative contractor
  has not found a reason to control the utilization
  of the particular service, procedure, or product.

4
Top 5 Questions Regarding Outpatient
Reimbursement for Wound Care
In this case, coverage will be based on medical
necessity as proven by the patients diagnosis
and the documentation in the medical record. Q.
4 How often should wound care professionals look
for updates to LCDs?   Medicare administrative
contractors may update LCDs as often as they deem
necessary. However some LCDs were updated 5 or 6
times a year. Therefore, wound care
professionals should assign someone to review
LCDs on a monthly basis. When LCDs are revised,
all wound care professionals should read them
carefully. Q. 5 Why do all wound care
professionals require reading the NCDs and LCDs
that pertain to the wound care work they
perform? Wound care professionals must know
these coverage rules. If a Medicare patients
medical condition aligns with the coverage rules,
the service/product/procedure has a good chance
of Medicare payment.
5
Top 5 Questions Regarding Outpatient
Reimbursement for Wound Care
If not, the wound care professional should
explain the coverage situation to the Medicare
beneficiary and give the beneficiary the
opportunity to receive and personally pay for the
necessary care. That is achieved by the wound
care professional providing the Medicare beneficia
ry with an Advance Beneficiary Notice of
Non-coverage and by the beneficiary signing the
notice and agreeing to pay for the care.   If you
wish to learn more about these and other
reimbursement topics, you and your revenue
cycle team may connect with Medical Billers and
Coders Experts  the only professional medical
billing and coding service provider that you can
trust.   To know more about our wound care
medical billing and coding services, contact us
at info_at_medicalbillersandcoders.com/888-357-3226.