August 28, 2015 | Net Health

3 Minute Read

Know Your Coverage Policies

Wound care is a business operating with specific rules and guidelines. The very root of proving you are working within stated clinical, financial, and operational guidelines is the data you’ll capture using your specialty electronic medical record (EMR). From the time a patient is called to schedule a service, the documentation process begins and medical necessity and coverage are confirmed and entered into the documentation system. Medical necessity guidelines can be payer specific, but most often payers follow the guidelines published by the Centers for Medicare & Medicaid ServicesVNational Coverage Decisions or Local Coverage Decisions (LCDs). The application of cellular and tissue-based products (CTPs) should be dictated by the clinical presentation of the patient as imparted by your LCD.

Let’s review a portion of the CTPs in a current LCD (Wisconsin Physician Services) titled ‘‘Application of Bioengineered Skin Substitutes (L30135)’’1 to further highlight the importance of understanding regulations and clinical decision making for proper payment:

‘‘Coverage Indications, Limitations, and/or Medical Necessity’’

This LCD covers the use of skin substitutes and related products in the treatment of lower-extremity ulcer disease. The LCD does not pertain or otherwise apply to the use of any skin substitutes or related products in the treatment of burns or skin cancer or for true reconstructive surgery.

Read the rest of this article in Advances in Skin & Wound Care.

An excerpt from an article originally published in Advances in Skin & Wound Care, written by Cathy Thomas Hess, BSN, RN, CWOCN, VP and Chief Clinical Officer at Net Health.

Share this post

Subscribe and See More