Top 5 Outpatient reimbursement questions for Wound Care

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Top 5 Outpatient reimbursement questions for
Wound Care

• Do outpatient reimbursement 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.
• Below are top 5 questions that clarify outpatient
  reimbursement questions for wound care
• 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.
• Theres always a coding confusion and diagnoses
  typically needs 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

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Top 5 Outpatient reimbursement questions for
Wound Care

• Define patients clinical status and to treat
  their complex medical conditions
• Coordinate care among providers, and support new
  payment methods that drive quality of care
• 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.
• In this case, coverage will be based on medical
  necessity as proven by the patients diagnosis
  and the documentation in the medical record.
• 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.
• 5. Why do all wound care professionals require
  reading the NCDs and LCDs that pertain to the
  wound care work they perform?

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Top 5 Outpatient reimbursement questions for
Wound Care
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. 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 beneficiary 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 MBC
experts the only professional medical
billing and coding service provider that you can
trust.