How to Improve Reimbursement through Wound Care Billing Services?

In the present healthcare environment, wound care specialists need to benefit from all accessible reimbursements avenues incurred from giving patient care and wound care supplies and dressings. But, when it comes to reimbursements, there's one problem, the rules keep on changing constantly.

Clinicians are constantly tested to make sure their patient care decision comply with the current Medicare reimbursement rules. What's more, in case you're not certain about today's guidelines, be prepared for the rules to change tomorrow.

The Patient Protection and Affordable Care Act of 2010, as revised by the Health Care and Education Affordability Reconciliation Act, will once again force a change in provider repayment in the upcoming year. Hospitals and clinics, especially the ones dealing in wound care will be rewarded if they meet certain quality measures characterized by Medicare; and clinics that don't meet these measures will be penalized by reduced reimbursement.

From 2013, the basic Diagnosis Related Group (DRG) payment amount has decreased as follows:

  • FY 2013: 1% Decrease
  • FY 2014: 1.25% Decrease
  • FY 2015: 1.5% Decrease
  • FY 2016: 1.75% Decrease
  • FY 2017: 2% Decrease

While these abatements may seem to be little, but within a wound care centers overall reimbursement, they're noteworthy and should be counterbalanced to guarantee the clinic remains fiscally solid. As per Medicare, money saved by these decreases will go toward value based purchasing incentive to doctor's facilities that meet or surpass quality performance standard. Later on, a similar payment plan is certain to carry over to long-term acute-care facilities, rehabilitation facilities, and skilled nursing facilities.

However, one vital question that would emerge at this point of time is, how will the wound care specialists go about in completing their medical billing and coding prerequisites. This is vital because, the ever changing Medicare scenario every year brings about new codes and billing requirement, and most of the times the in-house staff is unable to cope up with these changes. One valid and cost-effective solution to deal with this problem would be to outsource wound care billing and coding services. This will greatly reduce the errors and make the income cycle speedier.

Tips to Improve Reimbursements

Clinicians and wound care centers will still be able to get reimbursed as long as they pay attention to detail. To get maximize repayment, follow these tips:

  • Ensure that the products and services used by the clinic to treat the wounds are coded with the Healthcare Common Procedure Coding System (HCPCS) for Medicare reimbursement. The choice to utilize certain items is mainly influenced by executives, who depend on the hospitals formulary committee to recommend the best and most cost-effective products.
  • Make sure that the patients' health chart incorporates current lab results and dietary assessment. Keep in mind that Medicare requires patients to meet all necessities for specific items and services. In a Medicare review, archiving this data in the patient chart to show the patient qualifies efficiently to prevent you from getting reimbursement.
  • Verify that injury measurements are reported and staged accurately in the patient's document. The patient's acuity level dictates the services and products Medicare will reimburse to the healthcare service provider.
  • The last reimbursement tip would be to find a top class outsourced medical billing and coding vendor, who can do the tedious job for you. A coder who knows his or her way around ICD9 and ICD10 codes is the deciding factor in the Revenue Cycle Management. A wound care specialists can optimize their billing process by hiring a billing agency that are always updated with latest Medicare and Healthcare related changes. Also, it pays off to outsource as the operational costs to run a wound care clinic comes down drastically. It presents clinicians with faster income cycle, lesser AR days, claims denial are reduced, patient verification is accurate, and most importantly no errors in wound care billing and coding requirements.

Published By - Medical Billers and Coders
Published Date - Dec-16-2016 Back

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