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5 Key Strategies to Avoid Denials in Wound Care Billing

September 04, 2015

5 Key Strategies to Avoid Denials in Wound Care Billing

Wound care billing entails medical records to support each of the coverage requirements. While billing for rendered wound care services, it is vital to review the patient’s medical record and understand what services were actually provided to the patient. Considering all the reimbursement deductions over the last few years, wound care centers need to bill for every service they perform.

With the changing healthcare landscape large numbers of Wound Care centers are shifting from private practices to hospitals hence changing their billing needs as well. As is the case with any other specialty, wound care too calls for attention to detail and correct knowledge of codes to be used. With the introduction of new healthcare reforms of which the Affordable Care Act (ACA), popularly known as Obamacare is one which has brought a lot of changes, many wound care practices have seen a downward trend and stringent regulations have contributed in higher rate of denials. Further, the ICD-10 coding has brought its burden. However, there are ways in which denials can be evaded so that your practice can experience a smooth flow of revenue.

  1. Educate the staff
    In light of lack of appropriate knowledge, the staff cannot do much to analyze the reasons for denial nor avoid future denials. Deeper the training and knowledge provided, more the tools available to ensure accurate documentation and subsequently the financial success. Centers must focus on the current laws and regulations to ensure the staff is updated. This will eventually help in bringing about a low to no denial rate. Various insurance carriers offer full benefits or settle claims only if pre-authorization is taken prior to providing medical services. Hence your medical staff must be well trained about the importance of taking pre-authorization at the time of patient walk-in.
  2. Know what RAC auditors are examining
    Wound care is on the RACs' hit list right now, and it can be frustrating when money is taken back from a center. This happens even on legitimate claims when the documentation is reviewed and determined to be incomplete.
  3. Make use of EMR/HER
    Ensuring proper patient data and rendered service record in your system will eventually help in avoiding claim denials. Automated billing not only makes the process more efficient but reduces any scope for errors in record keeping.
  4. Coding changes to be revised
    Most wound care practices experience denials largely due to incorrect codes for procedures performed. ICD-10 codes applicable to wound care are extremely specific and it is imperative that these updates are revised in your system.
  5. Guarantee compliance
    A failure in HIPAA can also lead to penalties or claim rejections. Thus, HIPAA compliance must be guaranteed while transferring medical data for claim filing.

It is an established fact that denials are inevitable but they have ways to work around them so as to avoid them and subsequently reducing financial losses.


Category : Best Billing and Coding Practices