Wound Care
Skin substitute reimbursement, debridement upcoding, and Medicare prepayment review for wound care providers.
Medicare Advantage Plans Denying Wound Care and Skin Substitute Claims
Medicare Advantage plans apply their own coverage criteria to wound care and skin substitute claims, and those denials run on a se…
Skin Substitutes in Nursing Home Residents: Audit Exposure
Skin substitute claims for nursing home residents can violate Medicare's SNF consolidated billing rule before medical necessity is…
Skin Substitute LCDs: Where the Coverage Rules Stand
CMS withdrew the 2026 skin substitute LCDs in December 2025, but the $127.14 per sq cm payment rule and the new audit exposure it…
Wound Care Management Companies: MSO Structure and Fee Risk
How the clinician-owned practice and management company split in wound care draws corporate practice and anti-kickback scrutiny.
Timely Filing Denials on Wound Care Claims
A wound care claim that misses Medicare's 12-month filing deadline, even one delayed by prepayment review, can be denied with no r…
WISeR Prior Authorization Denied for a Skin Substitute: Next Steps
A non-affirmed WISeR request is not a denial. What to fix on resubmission, when to request peer review, and when the standard appe…
Surgical Dressing Claims: Supplier Records Under DME MAC Review
Home dressings bill to the DME MAC on a track separate from the clinic's procedure claims, and that track draws its own contractor…
Selective vs Non-Selective Debridement: CPT 97597, 97598 and 97602
Selective debridement (97597, 97598) and non-selective debridement (97602) are coded and reviewed differently, not interchangeable…
Arterial Ulcer Documentation and Vascular Assessment Records
Medicare reviewers test arterial ulcer claims against the vascular assessment, perfusion findings, and whether the diagnosis code…