A patient's insurance coverage for wound care treatment is largely dependent on the supporting documents that need to be submitted. Many a time wound care billing services are put to hardship when reimbursement is delayed or denied, leading to cost escalations that keep piling up. In order to prevent getting bogged in such situations, it is important to understand the intricacies of healthcare rules for medical coverage and learn about the best practices, which can help in speedier reimbursement.

Coding Procedures

It is vital that all medical procedures and services are coded correctly and comply with the guidelines set by the Healthcare Common Procedure Coding System (HCPCS). Note that improper documentation and usage of incorrect HCPCS codes will only lead to denial of reimbursements for any specific wound care treatment or product, whichever the patient is entitled to.

Specific details of wounds

In order to get speedy insurance reimbursement wound care billing services providers need to ensure that every single wound is documented accurately. The exact length and size (measure the width and the depth) need to be documented and need to figure in the patient's file clearly. It is better to take photographs from various angles and include them along with other details.

Ordering Wound care Supplies

Wound care billing services need to insist that practices do not fail to order wound care supplies else they become difficult to come by. Most pharmacies or local suppliers do not keep enough stock of all supplies. Wound treatment cannot be delayed due to the unavailability of essential supplies. There are several suppliers who undertake door delivery of supplies, which should be a great relief for some patients.

Charts and documentation

For speedy reimbursement of procedures or wound care products, it is vital that wound documentation like wound notes or wound progress notes are maintained properly. After every visit, the patient's chart needs to be updated and completed immediately. It is important that the authenticator signs the document with the date filled in. Please note that sans accurate and detailed documentation, the reimbursement is likely to be denied citing ineligibility as the reason.

Coding and Billing

Wound care billing services providers would do well to realize that wound care procedure constitute a major portion of reimbursement income for medical facilities as well as doctors. Reimbursement is indeed a great challenge from the billing and coding point of view. Remember that wound care includes wound treatment as well as evaluation and management (E/M). Please note that codes 97597 and 97598 need to be used for wound assessment and evaluation. Inappropriate use of modifier 25 can lead to denial of reimbursement. If hyperbaric oxygen needs to be used where other wound management procedures did not work, a physician's order is essential, without which reimbursement will be denied.

Assign billing tasks to specialists

In order to ensure hassle-free disbursement, it is important to assign medical billing tasks to specialists who know their job. Documentation needs to be accurate and cover all aspects including treatment and supplies that were found to be essential for the treatment process. Along with proper patient/wound care documentation, it is important to ensure that essential wound care supplies are made available and delivered on time.

Although some amount of confusion is bound to prevail when it comes to wound care management and the services offered, it is important that proper documentation is carried out. The use of appropriate billing and coding needs to be ensured by wound care billing services to ensure reimbursements are not denied and made on time.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. To know more about our Wound Care billing and Coding services, contact us at

Published By - Medical Billers and Coders
Published Date - Sep-07-2016 Back

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