Many of the present day Wound Care Centers (WCCs) provide patients a specialized level of care using various wound care procedures that are managed by Qualified Healthcare Professionals (QHPs) from different specialty fields like medicine, podiatry, and plastic surgery. However, these QHPs are sometimes or one can say even most of times are challenged by reimbursement issues, limited therapy and dressing options, limited access to multidisciplinary team members, and cost-driven factors unique to WCCs.
However, the moot question that stands vital in here is, are Wound Care Centers maintaining good profit margins with Medicare alone or is there some other reason for the expansion of their bottom line.
Can Medicare alone aid in Amplifying Profits?
Recently, a very sorted and thought out article was published in Health Leaders Media that discusses the need for wound care facilities to be profitable based on Medicare reimbursement. Many of wound care experts also passionately feel same and said wound care centers deserve the same.
The voices for the same have been coming out for over ten years now with the belief that a wound center must be able to provide a strong margin on Medicare rates alone. However, one lingering thing that is making rounds in the Medicare circle is what impact will wound care physicians have once President Trump decides to repel Obama care with his own version of Trump care.
Many WCCs annual projections and daily estimated collections have been centered on Medicare Allowable rates, also known as wage index factor when adjusted only. They have often been challenged by financial teams at hospitals or outpatient facilities that were not allowing private payers and strong PPO contracts into account.
However, the stance on this development has remained consistent. If we can show a margin with only Medicare Allowable Rates, then anything else you receive will be gravy. Countrywide, over 65% of patients are insured by Medicare as their primary insurance. And since, the advent of Electronic Medical Record at most of the centers, wound care facilities are in a better position to track the trends of both reimbursement and of payer mix.
What’s the verdict?
Though there have been many changes to PPO, HMO, and IPA payers, Medicare have remained stable at around 63%-67% of the patient load for several years now. Interestingly enough, there’s also been a steady decrease in the average age of patients, which have attributed to the high occurrence of diabetes in younger populations. This approach to Medicare sustainability is not simply a focus on profitability, rather it speaks directly of the importance of Medicare to WCCs. Without focusing on Medicare rates, both now and in the near future as we watch dramatic changes in our healthcare system take place, wound centers will not be around to assist the next generation of patients. This statement is supported based on careful attention to collections, expenses, documentation, regulation changes, clinical outcomes and most importantly medical billing and coding. Keep in mind that it is not impossible to be profitable on Medicare rates alone, however, think in the future, it will be impossible to survive without being profitable on Medicare rates alone.
Importance of Precise Medical Billing and Coding
More often than not a wound care center is offering excellent patient care, while also maintaining the entire Medicare prerequisite. However, when it comes time to account for revenue, the in-house is left in the dark. While good patient care is important, a WCC that often fails to track its income cycle may soon see its doors closed.
A dedicated billing and coding department should be at the heart of every wound care facility and is crucial to the survival of a center. Also, offshore billing agencies benefit you around $300,000 of lost billings for a center and more than $200,000 in some other specialty.