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7 Tips to Maximize Reimbursement of Wound Care Treatments Covered by Medicare

7 Tips to Maximize Reimbursement of Wound Care Treatments Covered by Medicare

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Medicare reimbursement

Proper documentation during wound care treatments can maximize Medicare reimbursement.

A patient’s Medicare coverage for wound care treatment is impacted by the documents submitted. If reimbursement is denied wound care supply cost can add up quickly. In order to take full advantage of the current healthcare rules for coverage, clinicians should be aware of best practices ensuring maximum reimbursement.

1. Code All Procedures

Medical procedures and services must be coded in accordance to the Healthcare Common Procedure Coding System (HCPCS). Without proper documentation, including the HCPCS codes, reimbursement for specific wound care treatments or products may be denied.

2. Take Pictures and Measurements

Each wound should be documented with length and size (by width and depth) as a part of the office notes, and then included in the patient file. Photographs should also be taken for additional documentation.

3. Follow Wound Requirements

For advanced wound dressings, wounds must either be surgical in nature or debrided. In addition, they must be full thickness and the drainage must be indicated. For patients to qualify for medical insurance coverage for compression stockings, wounds must be venous or lymphedema in description and be open and measurable.

4. Order Necessary Supplies Promptly

Advanced wound care supplies can be difficult to find because many pharmacies and local suppliers have limited selection. To receive the necessary supplies promptly so that wound treatment can continue, take advantage of Advanced Tissue’s prompt home delivery of wound care supplies. Only 30-day supplies of the products ordered are delivered, so extra supplies are limited in case the wound treatment plan changes.

5. Track Wounds & Complete Charts

Wound documentation in the form of Wound Notes or Progress Notes are essential for reimbursement of procedures and wound care products. The patient chart should be completed and updated at each visit for accurate documentation and must be dated and signed by the authenticator. If proper documentation is not available upon request, a reimbursement may be deemed ineligible.

6. Designate Billing

Knowledgeable billing specialists are critical to maximize reimbursement opportunities for clinicians and suppliers. After the appropriate treatment is carried out, supplies are deemed medically necessary for treatment and documentation should be complete and accurate. In addition, although there is a delay in the ICD10 October 2014 implementation to October 2015, the upcoming changes will result in an increased number of codes and a need for detailed planning pre-launch.

With complete patient care documentation, the reimbursement of wound care treatments covered by Medicare can be ensured. With proper care also comes the need for the proper wound care supplies and efficient delivery. Advanced Tissue offers clearly packaged and labeled wound care supplies for dosing and dressing individual wounds. Immediate clinician care and at-home patient care is simplified with our unit dose packaging, which is available through our easy ordering system. For more information on Medicare coverage of wound care treatments for your patients, feel free to contact one of our representatives.


Download our FREE Wound Treatment Product guide for more information on proper wound care treatment for your patients.

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