Wound care has acquired a new significance as a healthcare discipline and due to a growing aging population in the US; a sizable portion suffer from ailments that expose them to the risk of wounds that require protracted wound care treatment.
The challenge it presents to physicians, hospitals and also to patients is that all types of wound care are not covered by insurance and the ones that are covered require a series of administrative activities, like proper documentation with accurate detailing of medical details of the treatment episode to establish insurance eligibility, which also involves maintaining and furnishing details to establish that the treatment was administered upon the advice of a physician and carried out in the physician’s presence when required.
But even before starting this cumbersome process to prepare and submit claims, care providers have to determine whether the wound treatment they are claiming reimbursement for is covered by the insurance coverage policy framed by Medicare and Medicaid (CMS), which requires familiarity not just with medical necessities but also with insurance coverage.
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