Make sense of wound care billing: turn your cents into reimbursement dollars.
How does a clinician determine appropriate billing for wound care services? For Medicare and Medicaid patients, billing-related regulations are developed and promulgated by the US Centers for Medicare & Medicaid Services (CMS). This article will show how to access and use the CMS Web site as a resource for finding necessary information pertaining to billing guidelines and appropriate codes, including edits that prevent billing multiple procedures together and the use of modifiers that may allow an additional billing. Further discussion focuses on the importance of regular visits to this Web site since it is regularly updated as changes occur in billing or reimbursement policies. Therefore, investing the time to check the site for the latest updates can make a critical difference in your success with reimbursement for wound care services.
Vargo
Deanna M
DM
Department of Ambulatory Care/Wound Care, Summa Health System, Barberton Citizens Hospital, Barberton, Ohio 44203, USA. dvargo@barbhosp.com
D000465:Algorithms; D000554:Ambulatory Care Facilities; D014487:Centers for Medicare and Medicaid Services, U.S.; D017047:Cost Sharing; D039702:Current Procedural Terminology; D005607:Fraud; D049228:Healthcare Common Procedure Coding System; D006801:Humans; D007344:Insurance Claim Reporting; D006278:Medicare / Q000191:economics*; D009720:Nurse Clinicians / Q000191:economics; D009722:Nurse Practitioners / Q000191:economics; D012051:Reimbursement Mechanisms / Q000458:organization & administration*; D017592:Skin Care / Q000191:economics / Q000451:nursing; D014481:United States; D014947:Wounds and Injuries / Q000451:nursing*