Reimbursement

Industry News's picture

by The Alliance of Wound Care Stakeholders

The Alliance of Wound Care Stakeholders played a key role in educating the FDA and its advisory panel on the role and real-world value of antimicrobial wound care dressings, as the FDA considered a regulatory classification of these products that could impact access and availability to wound care providers and patients.

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Thomas Serena's picture
digging a grave site

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

"Please don't bury me down in that cold, cold ground. I'd rather have them cut me up and pass me all around."
-John Prine

Fans of folk singer John Prine will recognize the homey lyrics describing his views on organ donation. Sitting at my desk a few weeks ago with John Prine twanging in my headphones, I began to slog through the new Noridan Local Coverage Determination on hyperbaric oxygen therapy.

Industry News's picture

by The Alliance of Wound Care Stakeholders

The Alliance of Wound Care Stakeholders' (Alliance) quarterly update provides an overview of ongoing advocacy initiatives to ensure access, coverage and payment to wound care procedures and technologies for patients. This update includes current action items, updates on key areas of focus from the past quarter, and future issues for the second quarter of 2016 that the Alliance is tracking that are of importance to the wound care community, including clinicians who may be impacted by policy changes.

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Mary Ellen Posthauer's picture
health care quality measures

by Mary Ellen Posthauer RDN, CD, LD, FAND

The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT) amends Title XVIII of the Social Security Act by adding a new section – Standardized Post-Acute Care (PAC) Assessment Data for Quality, Payment, and Discharge Planning. The goal of the IMPACT Act is to reform PAC payments and reimbursement while ensuring continued beneficiary access to the most appropriate setting of care. The act requires the submission of standardized and interoperable PAC assessment and quality measurement data by Long-Term Care Hospitals (LTCH), Skilled Nursing Facilities (SNF), Home Health Agencies (HHA) and Inpatient Rehabilitation Facilities (IRF).

Samantha Kuplicki's picture
DME products

by Samantha Kuplicki, MSN, APRN-CNS, ACNS-BC, CWS, CWCN, CFCN

Ordering wound care dressing supplies can prove to be a frustrating task for many providers and clinicians. Unfortunately, I have encountered many health care providers that describe feelings of dread when working with their durable medical equipment (DME) counterparts.

Product substitution has been a prominent issue, especially of late with many reimbursement changes coming down the pike. This can lead to revenue loss via providing the patient with clinic supplies, and frustration for all parties involved.

Thomas Serena's picture
value formula

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

"Price is what you pay. Value is what you get"
-Warren Buffet1

Lawrence Mills introduced the concept of Value Analysis to the manufacturing industry a half century ago. The basic idea entails analyzing the function and importance of the various parts of a product as they relate to cost. He derived the following equation2:

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WoundSource Editors's picture
icd-10 implementation

by the WoundSource Editors

With approximately 68,000 codes (nearly five times the number of codes as ICD-9), the ICD-10 system can seem daunting. In addition to an expansion in the number of codes, with flexibility for new code development, ICD-10 codes themselves are also longer in length using 3 to 7 digits versus 3 to 5 digits.

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Samantha Kuplicki's picture
wound care supplies

by Samantha Kuplicki, MSN, APRN-CNS, ACNS-BC, CWS, CWCN, CFCN

In the last installment of my blog, we discussed a brief overview of billing for wound care products and dressings (durable medical equipment or DME) in several common care settings. Let's talk about the Hospital Outpatient Department (HOPD) a little more in-depth. Again, we will use Medicare as the standard for payment policy, as many payors use them as a model for policy-making.

Thomas Serena's picture
authorization denied

by Thomas E. Serena MD, FACS, FACHM, FAPWCA

During the 2010 presidential campaign, Sarah Palin, the former governor of Alaska, quipped during a debate that then presidential candidate Obama's health care reform contained within it "death panels": bureaucrats with limited or no medical training making life and death decisions. She suffered interminable criticism for the comment and political fact checkers dubbed it the "lie of the year."