Billing for wound care supplies to Medicare or private insurance carriers has always been a challenge. Every payer has its unique billing guidelines and reimbursement policies making it difficult to receive accurate reimbursement for wound care supplies. In this article, we shared the top 5 tips while billing for wound care supplies which will help you to reduce claim denials and accurately bill insurance carriers. Most of the guidelines we followed in this article are referred from The Centers for Medicare & Medicaid Services (CMS) billing guidelines as most private payers consider it as a reference.
The definitions applicable to wound care supplies are found in the 42 Code of Federal Regulations (CFR) 413.65. For accurately billing for wound care supplies let's understand definitions of outpatient encounters; wound care supplies; and other applicable terminologies.
Once you understand top denial reasons, your billing team can take precautionary measures to avoid them. You can make required changes in your billing process flow to avoid these top denial reasons while billing for wound care supplies. Note that we referred to the Medical Review Department research report to identify top denial reasons.
As more private carriers are increasing deductible amounts and co-pays for DME services, it is imperative that patient benefits and deductible amounts be recorded prior to dispensing DME. If the patient’s deductible has not been met, the amount for the wound dressings or their co-pay amount needs to be collected at the time of dispensing. Make sure that your patients are aware of these amounts as many products cannot be returned (e.g., any opened wound dressing or used compression garment).
The allowable number of dressings per wound is most often determined by Medicare and is based on a 30-day period. Each product has its own unique purpose and design and it is imperative that the physician make the determination of how many units are covered in a 30-day period. It’s not always necessary to dispense items based on thirty days and each wound should be assessed individually to determine the frequency and duration of dressing changes.
Making sure that the number of dressings dispensed and the type of dressing being utilized matches the description of the wound in your note is vital. It is appropriate to dispense a full month's supply if you determine that the patient will need that amount based upon your description of the wound, among other contributing factors that could impact wound healing.
Private insurance varies by state, plan, and provider. When dispensing wound care products from your office, it’s always best to obtain benefits for all services you offer in your practice prior to the patient visit, including wound care supplies, in order to smoothly and quickly expedite coverage determination. While it’s not a common scenario, some carriers will not cover wound care supplies being dispensed by the physician. Learning which plans have this restriction is important. Adding wound care supplies to your list of items asked about when obtaining benefits will save a lot of time and frustration.
In the event a particular payer will not cover the items from your office, a local supplier should be able to accommodate your request. Make sure the patient has a prescription and it’s clear the items cannot be substituted, as many of these companies try to reduce their cost by providing the cheapest product possible to maximize their profits. Even though products may be in the same category, not all products are created equal. If the supply house values your business, it should be able to supply the products you request and maintain a healthy bottom line.
As you know there are a lot of factors that determine reimbursement for wound care supplies. Whether it’s payer reimbursement policy or individual patient plan coverage, it’s always challenging to receive accurate reimbursement while billing for wound care supplies. Wound care billing has always been a tough job requiring experienced wound care coders who have knowledge of coding guidelines for local and federal insurance carriers.
When you outsource your wound care billing to a medical billing company, you keep the headache of billing and coding to the billing company. You can focus only on your practice while the billing company ensures every single submitted claim gets reimbursed. Just complete a careful evaluation of the medical billing company and leave the headache of wound care billing to them.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services. We understand the unique billing challenges of wound care billing and shared these ‘top 5 tips while billing for wound care supplies’ for provider education. You can refer following reference links for a detailed understanding.
For more assistance needed in wound care billing and coding and to receive accurate reimbursement for your wound care supplies, email us at: firstname.lastname@example.org or call us: 888-357-3226.
A Step-by-Step Approach to Billing Wound Care Products Through Your Office
Medicare Coverage & Payment of Outpatient Wound Care Supplies
Cardinal Health Wound Care supplies 2022 Coding Guide