Top 5 Outpatient reimbursement questions for Wound Care

2. 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. • There’s 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:

3. 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 doesn’t. 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 patient’s 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?

4. Top 5 Outpatient reimbursement questions for Wound Care • Wound care professionals must know these coverage rules. If a Medicare patient’s 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.