Wound care medical billing is complex for several reasons. One is that it may take place in different kinds of facilities, even for a single patient, treating the same wound, such as when a hospital patient is released and wound care continues at an outpatient center. Each encounter must be billed correctly, including the code details indicating which location was used.
Wound care medical coding for inpatients frequently lacks sufficient documentation. Documentation lacks the clinical substance necessary to support medical necessity, and it doesn’t capture a physician’s clinical judgment and medical decision-making for performing the procedure. Doctors have been conditioned to document excisional debridement, but if you look at what they need for their own payment, they need to do a lot more than that.
In today’s financial climate, with costs rising and budgets being cut, it is especially important to have effective medical billing so that all claims are properly reimbursed. Most practices that don’t have specialists managing their coding and billing are losing significant amounts of revenue.
Most wound care patients come in on a referral and the referring physician’s office will usually have checked to see if their insurance covers your services—but you can’t assume that is the case. When each new patient makes an appointment, the wound care center must verify insurance coverage.
Wound care supplies include some very expensive products, such as cellular and/or tissue-based products for skin wounds, but reimbursements are going down. This means it is vital that every service delivered is properly coded and billed so there is no lost revenue due to claim rejections and denials.
Many insurers and payers require prior authorization for treatment and will reject a claim that isn’t authorized in their system, even if it is something they would have authorized and paid, so it is important to find out about authorizations when confirming that the exam/visit is covered. Wound care also may be ongoing over a period of time and require additional authorizations, so staff must be proactive and attentive to such limitations.
There have been disagreements, and debates between what’s considered to be a “wound” versus an “ulcer.” Sometimes, ICD-10 is almost like its own language, and this is one of those situations. Be aware of ICD-10 semantic, that medical staff often make mistakes. While many clinicians may interchange the terms “ulcer” and “wound” as if they are substitutes, they are not other words when it comes to ICD-10 medical coding.
One has to understand the difference between wound debridement, open fracture debridement, and active wound care coding. Also, there are errors in coding when skin grafting/replacement is involved.
Medical Billing Service Fee
Our average billing fee ranges from 2.5% to 7%. We offer add-on services like provider credentialing, old AR clean-up, and patient collection. We don’t have any start-up fee or software setup fee. We don’t use restrictive, long-term contracts. You can cancel your agreement at any time with only 30 days’ notice. You can call us at 888-552-1290 or request a customized quote by submitting the inquiry form below.
Our billing team has great expertise in following billing softwares. If you choose our billing services, you don’t have to change your current billing software. We will continue from the point where your last biller had left. So no claims or denials will remain unattended. In simple words, peace of mind for you.
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