It has been stated time and again that billing is the mainstay of every wound care program. Errors in billing can impact the bottom line quite drastically and must be avoided at all costs. Gathering demographic and insurance information at the patient’s first visit is a must. Tools and technology must be used to verify the information. And the data must be entered into the system correctly. All these nuances if validated in time can reduce the revenue cycle by 30-60 days.
Checking wound care RCM services to ensure appropriate reimbursements:
Basics and audits: Accurate documentation needs to be maintained, else during audit money can be taken back from a wound care center. Hence accurate Medical billing and coding must be able to not just get the center paid timely; the center must be able to retain its earnings.
Relationship with finances (billing and coding): It’s imperative for physicians to not only focus on patient care but also be in touch with the finances of the wound care center. The center must be updated about rules and regulations concerning billing and coding. Due to constant changes in the reimbursement process, physicians and the clinicians should be knowledgeable about accurate documentation, and other revenue cycle management processes. There must be a low denial rate, if at all. Further, there must be set processes to ensure the same denial does not occur in the future. The charge masters must be set and at regular intervals, the entire revenue cycle of the wound care center must be reviewed.
Insurance and verification: As a patient visits the center, the healthcare staff must first and foremost verify the insurance information (as it tends to change often). Sometimes, prior authorization needs to be conducted for a certain procedure. This is an important aspect of the financial success of a wound care center.
Diagnostic specifics: Coders must ensure apt documentation by physicians before they begin coding for wound care services. Coders must also be cautious while reporting excisional/non-excisional (operative/non-operative) debridement as this involves a number of procedures related to the tissue (devitalized tissue, necrosis or Clough). Coders need to view the documentation thoroughly and code as per the procedure conducted, the instrument, and the technique used for wound care treatment. Further, providers must document all types of ulcers and their causes, precise location and depth of the tissue involved. The documentation must include the level of debridement, description of the wound and pain areas/control, and response to the treatment- bleeding, hemostasis, dressings. Coders must not code for vacuum-assisted closure; rather it should be done only for specific debridement. Coders also cannot code if the wound care is fundamental to another procedure (for e.g. do not combine graft/laceration closure to excisional debridement. And coders cannot code for multiple layers either, only for the deepest layer debrided.
Treatment: The notes must include wound dimensions, undermining or tunneling of the wound, wound base description, wound edges, tissue presence, drainage, odor, color, pain, changes in the wound, indications, ongoing treatment plans and next steps. Once the procedure is documented, coders must look for the treatment given. They must be aware of various types of treatment options apart from debridement such as topical wound care, off-loading, heel protection, controlling infection, local excision of lesion, debridement of open fracture, myectomy etc.
The wound care center must know at all times what they are getting paid; are there ways to treat patients which are less costly/cost-effective; does the documentation comprise details about services billed; do the claims reflect the procedures performed; the number and type of denials/rejections received and ways to prevent them. These questions are imperative to work towards a financially healthy wound care center.
Why Medical Billers and Coders (MBC)
As we approach the end of year-2017, it might be the time for you to calculate the Account Receivable (AR) for 2017 and have a better approach towards 2018. Medical Billers and Coders hold 17 years of experience in medical Revenue Cycle Management (RCM) with a skilled team coders and billers. Get a quote for your Wound care Specialty.