Medicare covers wound care for all beneficiaries, irrespective that it carried out inpatient or outpatient setting. Wound care can be expensive for patients. Few peoples may suffer from post-surgical lesions. Other patients may suffer from chronic fungal or viral wounds. Due to the prevalence of wounds with age, it’s simple to understand why Medicare would cover this treatment.
Wound care supplies are protective covers or fillers for openings on the body caused by surgical procedures, wounds, ulcers, or burns. These supplies are protected under Medicare Part B when they are medically essential for the treatment of surgical or debrided wounds. Wound care supply claims are processed by the 4 Durable Medical Equipment Regional Carriers (DMERCs).
Medicare Guidelines for Wound Care
Medicare provides reimbursement for surgical wounds. Also, Medicare covers chronic wounds. Medicare covers wound care supplies for various types of wounds. Few lessons are from surgeries, ulcers, burns, or flesh wounds. It depends upon how patients will receive wound care as an inpatient or outpatient will determine which part of Medicare will provide reimbursement.
Inpatient Wound Care Coverage
If the patient receives wound care inpatient like a hospital, skilled nursing facility, or rehab facility, coverage would fall under Part A. You must know that there is a deductible under Part A, but Medicare Supplement Plans will cover these deductibles.
What is covered under Medicare Part A?
Medicare Part A coverage:
- Hospital meals
- Semi-private room
- Special care units
- Drugs, supplies, and equipment
- Lab tests and X-rays
- Some blood transfusions
- Hospice care
- Operating room and recovery room
- Rehabilitation services during your stay
- Skilled Nursing care on a part-time basis
Outpatient Wound Care Coverage
If patients receive woundcare in an outpatient like at a doctor’s office, coverage would fall under Part B. It also covers Durable Medical Equipment (DME) if patients require it. This includes any supplies that are medically necessary to treat a patient’s wound. Part B also comes with a deductible. However, if the patient has a supplemental plan then it could be covered.
Wound Care Supplies Covered by Medicare
Medicare cover primary and secondary wound dressings for patient’s injuries. Primary dressing supply means which are directly applied on injury and secondary dressings mean which helps to the primary dressings e.g., bandages, gauze, and adhesive tape.
- Hydrogel Dressings
- Hydrocolloid Dressings
- Alginate Dressings
- Gauze
- Foam Dressings
Medicare Documentation
It is the physician’s responsibility to understand the rules and regulations and guiding the department’s documentation and billing processes. The patient’s medical record should include and clearly documented the progress of the wound’s response to treatment at each physician visit. Medicare covers wound treatment if the patient has the necessary documents.
- Size of your wound
- Evidence of your wound
- Any necessary drainage needs
- The level of damage patient’s injury is causing
Medicare Advantage Coverage
It’s difficult to predict that how much patients will need to pay out of pocket with Medicare Advantage Plan. You may need to contact the carrier directly to find out how much cover and how much out-of-pocket expenses will be. We at have experienced and trained staff to take care of all these things. We regularly conduct staff training to keep them updated with the latest updates.
Let us know the issues which you are facing in your current Wound Care practice. We will help you to increase overall your practice revenue by eliminating redundant errors.
You can reach out to us at: info@medicalbillersandcoders.com or call us at 888-357-3226.
