Wound Care
Skin substitute reimbursement, debridement upcoding, and Medicare prepayment review for wound care providers.
Consignment Skin Substitute Inventory: Expired Product and Records
Grafts held on consignment create inventory and expiration records that auditors use to match every billed unit to the product tha…
Appealing a Medicare Wound Care Overpayment Determination
Rebutting a Medicare wound care overpayment claim by claim: measurements, debridement depth, conservative care, product selection,…
Skin Substitute Application Coding: CPT 15271 Through 15278
CPT 15271 through 15278 split by anatomic site and measured wound area. A reviewer's first move is checking that split against the…
Hospital Outpatient Wound Center Billing: Facility and Physician Claims
One wound center visit produces two Medicare claims from the same chart, under different rules for documentation, supervision, and…
Continuing Skin Substitute Applications When a Wound Is Not Healing
When a skin substitute graft does not close a wound on schedule, the record must show why continuing, changing, or stopping the co…
Commercial Payer Audits of Skin Substitute Claims
Commercial plans audit skin substitutes under their own medical policy and provider agreement, not Medicare's LCD, with network te…
Billing an Office Visit on the Same Day as Debridement
Modifier 25 lets an E/M office visit and a debridement procedure pay on the same date, but only when the visit documents work the…
Advance Beneficiary Notices for Non-Covered Wound Care Services
What a wound care ABN must state before a skin substitute or debridement claim Medicare may deny, and why a missing or invalid not…
Wound Care Practices Facing Prepayment Review
How wound care practices manage the cash-flow hit of Medicare prepayment review and what actually meets the error-rate criteria th…