Wound Care
Skin substitute reimbursement, debridement upcoding, and Medicare prepayment review for wound care providers.
UPIC Audits of Wound Care Practices: What Triggers Them
UPICs select wound care practices through data analysis, not complaints. What the outliers look like, and the compliance check tha…
Skin Substitute FCA Enforcement: The Government's Theories
DOJ's $309M Apex Medical settlement maps three theories driving skin substitute enforcement: pricing spreads, medical necessity, a…
Wound Care Prepayment Review: Documentation That Releases Claims
CMS prepayment review holds wound care claims until the record proves medical necessity. The ADR deadline and what reviewers check…
Physician Office Wound Care Billing: Site-of-Service and Supply Audits
Physician office wound care billing faces two audit vectors: place-of-service mismatches and skin substitute supply-line errors.
Wound Care LCD Compliance: Coverage Criteria by Documentation Element
Medicare LCDs condition wound care coverage on documented conservative care, 30-day progress checks, and a medical necessity narra…
Skin Substitute Audits: Product Selection, Size, and Frequency Findings
How the LCD framework, wastage documentation, and application-count rules drive skin substitute audit findings after CMS's 2026 pa…
Medicare Wound Care Documentation: The Chart That Survives Audit
What Medicare requires in the wound care chart: measurements, photographic evidence, treatment-plan progression, and signature req…
Debridement Coding Audits: Depth, Documentation, and CPT 11042-11047
Medicare auditors compare CPT 11042-11047 excisional debridement claims against the depth documented in the chart to build recoupm…
Feds Seize $2 Million From Pasadena Wound Care Clinic Amid Data-Driven Medicare Fraud Allegations
In a stark reminder of the federal government’s enhanced capability to rapidly freeze the assets of its enforcement targets, the U…