Reimbursement

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.

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."

By Catherine T. Milne, APRN, MSN, BC-ANP, CWOCN-AP

My grandmother knew wound care. "Soak it in salt water," she'd say. "Keep it open to air!" she would emphatically declare the next day. You never knew what to expect. We've all heard the sage old dermatology advice "If it's wet, keep it dry, and if it's dry, keep it wet." Perhaps my grandmother was a guest lecturer at a dermatology conference and they were too intimidated not to incorporate her wisdom.

By Bruce E. Ruben MD

Have you noticed that in the fictional future, such as in the Star Trek universe, nobody uses money to pay for medical care? When you get sick, a starship medical officer scans you with a handheld diagnostic device, and then injects you with the perfect cure. No copays or deductibles. No making copies of your driver's license and insurance card. No reimbursements from insurance companies. And no explanation is ever given for how such a free society exists in the future.

By Michel H.E. Hermans, MD

In the June 2015 issue of the Journal of Ostomy Wound Management, Bell et al. published an article in which they reacted to the recent decision by CMS (January 22, 2015) to change its HCPCS code for a Manuka honey dressing for Medicare Part B patients to a non-covered code. Apparently, this ruling was based on the fact that the dressing is impregnated with more than 50% (by weight) honey. The authors, rightly so, stated that this would be a major loss for a significant number of patients who, under the previous ruling, would have been able to use the dressing as a reimbursed material. Indeed, this specific dressing is one of the materials with a good record with regard to clinical proo

By Samantha Kuplicki, MSN, APRN-CNS, AGCNS-BC, CWS, CWCN, CFCN

It is becoming increasingly difficult to be involved in wound care at any level without having a working knowledge of the intricacies of varying policies regarding surgical dressings for wounds. Care setting, Medicare Administrative Contractor (MAC) for your geographic region and pertinent DME Local Coverage Determinations (LCD), type of dressings desired, and wound assessment are all factors that clinicians responsible for ordering supplies should be aware of. For practical purposes, we will mainly discuss Medicare as a reference for payors, as many commercial, contracted, and private payor policies are modeled after Medicare* policies.

By Michel H.E. Hermans, MD

The 10 year old son of friends of mine incurred a gash in his right knee. After the injury, he was able to walk without pain in the leg (the gash did hurt, of course) but was taken to the hospital by ambulance. There, an X-ray of the knee was taken which did not show any fractures or other non-skin injuries. The gash was sutured and the patient was referred to an orthopedic surgeon for regular checks of the sutures and for suture removal. Sutures were to be removed 14 days after the accident. On that day, the orthopedic surgeon had no office hours.

By Michel H.E. Hermans, MD

With a recent acute and serious vision problem, I have had to visit three ophthalmologists (all with different specialties) and a neurologist. I have undergone a series of tests, on the eyes as well as an MRI of the skull, brain and orbita, tests for the coagulatory system, atrial fibrillation and an ultrasound of the carotids.

By Lydia A. Meyers RN, MSN, CWCN

Today's health care changes are a necessity. Unfortunately, both the country's economy and overspending with abuse of the system contributed to this need for change. What are the predictions for the future? How can educated health care professionals prepare for the future and protect themselves? How will these changes affect wound care and wound care nurses? Within this blog, I will try to answer these questions with information gained from life, education, lifelong research, critical thinking, and looking outside of the box.

By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

Patient safety is always of the utmost importance. Health care providers aim to improve the health of others. Having been in many settings during my career, I have been privileged to see the transition of how nursing has changed due to technological advances. Long gone are the days sitting in rural Vermont trying to decipher handwritten orders, counting drips on a dial control IV set and doing pediatric drug calculations while a parent hovers over you. Luckily, we have made strides to eliminate such frustrations, ways of frequent error, and time consuming tasks. Nursing has been forced to evolve as technology evolves.