How Technology Helps Wound Care Providers Navigate Change

Consider the realities facing today’s wound care providers. Inaccurate or incomplete billing is no longer just a paperwork issue; it can mean delayed payments, revenue loss, and compliance risk. CMS, Medicare Advantage plans, and commercial payers are enforcing increasingly stringent documentation, quality metrics, and audit standards. And in an environment where patient complexity is rising, margins are tightening, and reimbursement is value-based, the pressure is on. 

Layer in the demands of uncertain and changing regulations (e.g., Local Coverage Determinations/LCDs), prior authorization mandates (e.g., hyperbaric oxygen therapy /HBOT or skin grafts), fraud prevention initiatives, and new data sharing rules, and the reality is clear: wound care teams must adopt smart, integrated and innovative technologies or risk falling behind. 

What does it all mean? We are entering the era of a digital-first wound care ecosystem. At its center is the clinician, empowered, not replaced, by the right technology and solutions. This chapter explores how innovation supports resilience and reimbursement across these core domains: 

• Enhanced documentation and clinical reporting 
• Interoperability requirements and digital infrastructure 
• Artificial Intelligence (AI) and predictive analytics 
• Ambient clinical documentation and workflow integration 
• Regulatory changes affecting telehealth for wound care 
• Role of specialty EHRs and remote monitoring in quality reporting 

Documentation That Pays: Aligning with Regulatory and Payer Requirements  

In wound care, documentation is more than a clinical record; it’s the foundation of compliance, reimbursement, and care continuity. This is especially true in 2025, as CMS, Medicare Advantage plans, and commercial payers intensify their scrutiny of billing, medical necessity, and outcomes reporting. 

The shift toward value-based care has amplified these demands. Reimbursement increasingly hinges on traceable, quantifiable evidence that a wound exists, that treatment is necessary, and that the plan of care is delivering results. If it’s not documented in a defensible format, payers may not consider it delivered, or worse yet, the provider may face allegations of fraud. 

Under newly approved CMS quality measures for wound care and updated Merit-Based Incentive Payment System (MIPS) reporting guidelines, wound care providers must ensure that patient records reflect high levels of clinical specificity. At a minimum, best practices now include: 

• Objective wound measurements, including length, width, depth, and staging 
• Descriptions of tissue composition, such as granulation, slough, or necrosis 
• A clearly defined treatment plan, including debridement protocols, dressing selections, frequency, and healing goals 
• Photographic and timestamped evidence to support wound trajectory and treatment effectiveness 

The margin for error is slim. Vague language, like “improving” or “unchanged,” will not hold up to payer scrutiny or audits. Instead, documentation must tell a defensible, data-supported story of why care is being delivered and how it’s progressing. 

This is where technology becomes indispensable. Purpose-built EHRs with embedded wound care templates ensure providers capture the required details. Smart prompts, auto-populated fields, and guided workflows reduce the risk of omissions. Digital wound imaging, including mobile-based 3D modeling, adds further objectivity, while natural language processing (NLP) and ambient documentation tools reduce manual burden and promote consistency. 

In wound care programs — whether at hospitals, clinics, or private practices — structured, high-quality documentation is more than a best practice; it’s a cornerstone of operational efficiency and financial integrity. Clear, comprehensive records reduce claim denials and delays, support accurate coding and billing, and help ensure defensible audits. As reimbursement becomes increasingly tied to value, outcomes, and medical necessity, robust documentation safeguards revenue and supports long-term sustainability for programs of all sizes. 

Interoperability Countdown: Preparing for 2027’s Reimbursement Realities 

Interoperability isn’t just a technology buzzword — it’s a strategic necessity tied directly to reimbursement efficiency and regulatory compliance. In January 2024, CMS issued the Interoperability and Prior Authorization Final Rule (CMS-0057-F), extending key interoperability deadlines to January 1, 2027. By that date, impacted payers, including Medicare Advantage and Medicaid, must implement (Application Programming Interface) APIs to share prior authorization and patient data more transparently with providers. 

Although these mandates apply to payers, the ripple effects on wound care providers will be significant. Providers must ensure their EHRs are prepared to interface with payer systems that support the Provider Access API and Prior Authorization API. Doing so is critical to streamlining claims processes, reducing delays, and safeguarding revenue in the years ahead. 

Interoperability matters because reimbursement depends on timely, accurate information flow. When documentation, prior authorization status, or claims histories are delayed or missing, so are payments. For wound care teams — already working within narrow margins and under growing audit scrutiny — this can disrupt operations and compromise patient care. 

EHR systems that are up to today’s regulatory demands position wound care programs to stay ahead of these changes. They also enable better coordination across care settings — reducing duplication, supporting continuity of care, and promoting data-driven decision-making. For private practice, outpatient wound centers, home health teams, and hospital-based programs alike, aligning now with CMS’s vision for data exchange is a move toward reimbursement resilience. 

CMS requires impacted payers to implement interoperability APIs by January 1, 2027. Wound care providers should prepare now to ensure smooth data exchange and avoid disruptions.

Source: CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)

From Voice to Value: How AI and Ambient Tools Advance Reimbursement 

Artificial Intelligence is no longer theoretical in wound care. CMS is encouraging providers to incorporate AI-powered tools into documentation, diagnostics, and patient engagement processes — especially as part of its burden-reduction initiatives. While reimbursement for these tools is not yet standard, their clinical and operational advantages are becoming clear. 

AI can support: 

• Automated wound measurements from digital images 
• Predictive modeling to flag wounds at risk of deterioration 
• Natural language processing for faster charting 
• Smart prompts to improve coding and clinical accuracy 

When integrated with a specialty EHR, AI doesn’t just reduce keystrokes; it changes how clinicians work. It helps ensure documentation is complete, coded correctly, and submitted on time. These features reduce denials, improve care continuity, and enhance performance reporting for value-based care and other payer programs. 

Ambient clinical documentation takes this a step further. These tools allow providers to conduct visits as usual while the AI securely listens, transcribes, and structures notes in real time. After the visit, clinicians can review and approve the draft. This technology preserves the human element of care — face-to-face interaction — while eliminating the need to document every detail manually. 

In wound care, where patient engagement is critical and visual/tactile assessment cannot be rushed, ambient documentation allows clinicians to focus fully on the patient. It’s especially valuable in high-volume clinics, where providers can regain hours of time each week, enabling them to increase volume and revenue.  

According to the 2025 Net Health Source Report for Wound Care, in a survey of 200+ wound care leaders nationally, over 75% of respondents expressed a positive outlook on AI’s role in wound care, and 68% believe it will reduce administrative burden while improving outcomes. 

Telehealth in Transition: New Rules and Realities for Wound Care 

Telehealth proved to be a lifeline for many patients during the pandemic, and wound care providers responded with innovation, using mobile imaging, virtual consultations, and care coordination apps to keep patients safe and on track. But in 2025, the rules are evolving. 

Recent legislation, including the Full-Year Continuing Appropriations and Extensions Act, 2025, has extended many Medicare telehealth flexibilities through September 30, 2025. This means that wound care providers can continue offering telehealth services to patients in their homes, regardless of geographic location, until that date. Afterward, unless new legislation is enacted, Medicare is expected to reinstate the pre-pandemic geographic and originating site restrictions, limiting reimbursement to patients located in rural or designated shortage areas. 

However, CMS has also finalized certain flexibilities that allow audio-only visits for patients in their homes if video technology is not feasible or declined. Until September 30, 2025, wound care clinicians can continue to leverage a range of digital platforms, ensuring continuity of care and reducing unnecessary travel for vulnerable patients. 

Providers must still meet CMS’s technical and documentation requirements. Most services require two-way, real-time audiovisual communication unless audio-only use meets specific criteria. For wound care, this presents an opportunity to maintain virtual care for eligible patients while preparing for potential policy shifts later in the year. 

As providers look to the future, success will hinge on flexibility and investing in scalable platforms that can pivot as new payment models and legislation evolve. 

Specialty EHRs: The Infrastructure for Wound Care Today 

As some providers have discovered, generic EHRs can’t keep up with the specificity and compliance demands of modern wound care. Specialty EHRs, designed with wound assessment protocols, smart templates, and visual documentation tools, are emerging as indispensable. These platforms do more than just digitize records — they form the foundation for a value-based, data-driven care strategy. Benefits include: 

• Assessment Accuracy: Specialty EHRs that can incorporate digital and 3D mobile imaging capabilities allow for precise evaluation of wound size, depth, and tissue composition. This level of granularity supports consistent documentation and improves clinical decision-making, leading to more effective, personalized care plans. 

• Enhanced Coding Accuracy: With integrated coding support, these systems reduce reliance on memory or manual lookup. Templates and tools help ensure that CPT and ICD-10 codes are correctly applied, reducing errors and denials that delay reimbursement. 

• Comprehensive Documentation: Smart phrases, auto-fill features, and structured templates streamline the note-taking process and reduce documentation fatigue. These features increase consistency, support audit readiness, and align with payer expectations for clarity and completeness. 

• Improved Reporting: Robust reporting tools allow clinicians and administrators to track healing progress, compare performance against CMS benchmarks, and monitor compliance across the patient population. These insights also support internal quality initiatives. 

• Benchmark Tracking: Specialty EHRs enable providers to monitor their performance in the context of regulatory requirements, from MIPS to Medicare Advantage quality measures. With customizable dashboards, clinicians can proactively address care gaps before they affect outcomes — or payment. 

Beyond documentation, specialty EHRs are foundational for integrating new technologies. These emerging capabilities enable continuous, coordinated care outside the clinic’s walls. A wound that stalls in healing can trigger an alert, prompting an intervention before complications set in. These capabilities are especially valuable in bundled payment and value-based models, where proactive management directly impacts outcomes and reimbursement. 

Strategic Steps Toward Reimbursement Resilience Through Technology 

Building reimbursement resilience isn’t just about weathering change; it’s about using the right tools to stay ahead of it. For wound care providers, technology can be a strategic asset. But simply adopting digital tools isn’t enough. Organizations must take targeted steps to ensure that their technology investments translate into stronger financial and clinical performance. Toward that end, there are several key issues to consider. 

1. Optimize Documentation with Purpose-Built EHRs 
Generic EHRs often fall short in wound care. Specialty wound care EHRs, especially those designed to support current regulatory demands and beyond, enable more detailed, compliant documentation. These platforms reduce the risk of incomplete entries that can jeopardize reimbursement. Systems should be capable of capturing clinical photos, precise measurements, and treatment protocols in formats that align with payer requirements and CMS quality metrics. 

2. Integrate AI-Powered Imaging and Predictive Tools 
AI-enabled wound imaging doesn’t just automate measurements — it standardizes documentation, enhances coding accuracy, and supports longitudinal tracking. When combined with predictive analytics, these tools can flag patients at risk of poor outcomes, allowing earlier interventions and strengthening performance in value-based care models. 

3. Streamline Workflow with Interoperability and APIs 
Prior authorization bottlenecks and siloed data remain major obstacles to efficient reimbursement. Platforms that support API-based data exchange ensure real-time communication across EHRs, payers, and clinical teams. This will be critical as CMS mandates the Provider Access API and FHIR-based data exchange by January 1, 2027 under the Interoperability and Prior Authorization Final Rule (CMS-0057-F). 

4. Build a Culture of Technology-Enabled Compliance 
Technology only drives value when it’s used intentionally. Wound care leaders must foster a culture of compliance by training staff, auditing digital workflows, and continuously aligning documentation practices with payer requirements and CMS changes. Success lies not just in the tools themselves — but in how effectively they’re deployed. 

Technology isn’t a guarantee — but with the right strategy, it can be a powerful shield against revenue loss and a springboard for smarter wound care practice that delivers better outcomes.