Wound Care
Skin substitute reimbursement, debridement upcoding, and Medicare prepayment review for wound care providers.
Wound Care Kickback Exposure: Manufacturer Relationships
Rebates, consulting fees, and free skin substitute product tied to referral volume can trigger Anti-Kickback Statute and False Cla…
Wound Care in Skilled Nursing Facilities: Audit Exposure
SNF consolidated billing bundles most wound care into the Part A rate. Facility, practitioner, and Part B billing splits are drawi…
Venous Leg Ulcer Care and Compression-Therapy Documentation
Medicare pays for compression bandages only over a qualifying wound. The same chart entry backs the pump, the graft, and every cla…
Skin Substitute Distributor Arrangements and Enforcement
A $309 million DOJ settlement shows how distributor commissions and pricing spreads on skin substitutes become Anti-Kickback Statu…
Selective Versus Excisional Debridement Documentation
Selective and excisional debridement pay differently and require different proof. What the operative note must show, and why wound…
Selecting a Skin Substitute: Documenting Medical Necessity
How to document product selection, conservative care, and wound measurement so a skin substitute claim holds up under Medicare's 2…
Product Purchase Records in Skin Substitute Audits
UPIC and MAC auditors now compare skin substitute purchase records against billed units. A shortfall between the two is becoming t…
Pressure Ulcer Staging and Billing Accuracy
How pressure injury staging errors and present-on-admission coding gaps translate into HAC payment reductions and audit exposure f…
Physician Supervision in Wound Care Clinics
How incident-to billing rules tie wound care claims to direct or general physician supervision, and why undocumented supervision d…