Reimbursement

By Lydia Corum RN MSN CWCN

The times are changing in the world of wound care. There used to be a time when there were no problems with reimbursements, as long as the doctor wrote the order. Today, the Centers for Medicare & Medicaid Services (CMS) regulations confuse clinicians and make the world of healing wounds much more difficult. The changes are in the area of denials with not enough information given for choosing dressings, use of negative pressure therapy and hyperbaric oxygen therapy. Are all these changes needed? Why are these changes happening? What can hospitals and wound clinics do to make things better?

Paula Erwin Toth, RN, MSN, FAAN
WOC nurse

By Janet Wolfson, PT, CLWT, CWS, CLT-LANA

by Marcia Nusgart, Executive Director, Alliance of Wound Care Stakeholders

Editor's note:This blog post is part of the WoundSource Trending Topics series, bringing you insight into the latest clinical issues and advancement in wound management, with contributions by the WoundSource Editorial Advisory Board.

By Paula Erwin-Toth MSN, RN, CWOCN, CNS, FAAN

As we embark on our journey into 2017, many are concerned about the road ahead. A new President and GOP dominated Congress have promised to make health care reform a priority. There have been numerous articles and opinion pieces written about the path these changes will take and what they will mean to patients, caregivers, and clinicians alike.

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

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 (LCD) on hyperbaric oxygen therapy (HBOT). It should not have come as a surprise that the Centers for Medicare & Medicaid Services (CMS) is planning prepayment review for HBOT services. We have been struggling for months in New Jersey, Michigan and Illinois with preauthorization. What is frightening is that a large number of the denials we have seen are completely nonsensical, bureaucratically driven, and dangerous: a patient with osteoradionecrosis of the jaw, for example, was denied because she didn't have 30 days of standard of care; or perhaps the CMS keyword search engine selected out a proscribed adjective!

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).

By Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTC

With approximately $20 billion being spent a year on advanced wound care supplies, cost containment is a sought after goal. Long-term care facilities battle cutting costs under one reimbursement system like everyone else, but I assure you this challenge can be simplified, while continuing to bolster quality of care. I have learned that to contain cost, you must use experience, knowledge, and strong project management. So how do we accomplish this? I have broken down a cost containment plan for your long-term care facility. These key points will help you.

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.

By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-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.