Wound Care
Skin substitute reimbursement, debridement upcoding, and Medicare prepayment review for wound care providers.
Conservative Care Requirements Before Advanced Therapy
Medicare will not cover a skin substitute graft or hyperbaric oxygen therapy without proof that conservative wound care failed fir…
Cellular and Tissue-Based Product Waste Billing
CMS ended wastage billing for skin substitutes effective January 1, 2026, and UPIC audits already test whether billed graft sizes…
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…