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Know About Wound Care Medical Billing

With a growing aging population in the US, wound care has significantly gained importance since a large portion suffer from ailments with the risk of acute and chronic wounds that require constant care. Not just the elderly, proper wound care plays an important role in the healing process in patients of all age groups. Caring for patients with such wounds is a challenge in itself, and topping up these challenges is the other side of the story; the frequent changes in regulatory requirements and billing guidelines, thereby making it difficult to get timely and accurate reimbursements.

The challenge is that all types of wound care are not covered by insurance and the ones that are covered require a series of administrative activities like proper documentation with accurate detailing and also accurate coding. Before claim submission, providers must determine whether the wound treatment falls under medical necessity guidelines and whether it is covered by the patient’s insurance policy. This requires familiarity with the medical necessity guidelines, insurance coverage policies, and prior authorization requirements.

General Challenges In Wound Care Coding & Billing

The codes alone do not determine the procedure coverage, and it is important to understand the rules under which you operate that code.

Most of the times, clinics miss to provide the add-on codes for the actual code. Not considering additional codes such as dimensions of the debrided area is one of the common errors made.

Inaccurate reporting of non-selective and selective debridement areas can be challenging for Wound care coding.

Reporting wound dressing separately and not reporting under E/M service is another issue.

In case of any chronic diseases, complete evaluation of patient’s medical records is required, including the list of procedures offered to treat the wound, follow-ups, photographs pertaining to progress of the wound etc.

Specificity of the wound is an important factor in determining the correct diagnosis code and most of the times providers fall short in documenting this.

The essentials of Wound care billing

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Description of the wound

A complete description pertaining to the wound is necessary that includes the size, appearance, presence of infection or any other underlying medical issue must be provided.

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Description of Treatment Method

The description of the debridement method and a detailed in-depth description of tissue layer that was subject to debridement during the procedure is required.

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Precise Information

The documentation provided should contain precise information on how the tissues were treated.

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Step by Step Overview

A step-by-step overview and documentation of the healing process and information regarding any other new medical intervention such as biopsy, podiatric consultation or vascular interventions is also essential.

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Outsourcing Wound Care Billing

Outsourcing Wound Care Billing

With the increasing magnitude of patients, wound care coding and billing is becoming an overwhelming task for private practices. The best solution is to outsource the wound care billing and coding for quality assurance measures and for best reimbursements.

Outsourcing helps you to ensure that the medical billing process is up-to-date and free of any possible human errors. It also lowers the overhead costs, maximizes payments, and minimizes claim denials and rejections. Over the time, you can see the claim reimbursements increasing and your Account Receivables decreasing so that you easily focus on your core responsibility – patient care.

How can Practolytics help?

Practolytics is your one-stop solution for all the medical billing, practice management, patient management, and revenue cycle management activities a healthcare practice needs to carry out.

Practolytics can address a wide variety of challenges that every Wound Care practice faces:

Best Practices

We define, review, and refine medical record requirements, regulatory requirements, insurance verification and operational workflows so the practice can stay compliant.

Billing & Coding

We help practices with best coding and billing practices to ensure claims are submitted with accurate information, ensuring timely adjudication by payers.

Denial Management

With robust denial management strategies, we help practices battle denials upfront with insurances and ensure no claim is left behind.

Process Efficiency

We help practices enroll and participate in activities such as Quality Payment Program to enhance practice efficiency and revenue sources.

Patient Experience

With a robust EHR in place and inbuilt telemedicine modules, we help practices enhance patient experience when it comes to Telehealth services.

Review & Training

We conduct periodic review of documentation and coding and provide appropriate education to the clinicians and staff to ensure best practices are implemented and followed within the practice.

A Platinum partner amongst 850+ billing companies, Practolytics is a 20+ year-old healthcare technology and revenue cycle management services company, providing medical billing service solutions to 180+ practices of all sizes spreading across 31 states and serving more than 28 critical specialties.

If you are looking for a trusted billing partner for your Wound care billing operations, Practolytics with its diverse background in every aspect of healthcare is your best bet. We can help you streamline your billing processes so that you can focus on your primary responsibility – patient care.

Optimize Your Wound Care Clinic Revenue

Practolytics expertise can help you in maximizing your Wound care clinic revenue.

3-4 days

From DOS to claim submission

12%

90+ days Insurance AR

95%

Claims paid in 90 days

94%

First pass ratio

100%

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