Wound Care Reimbursement Guide To Cellular and Tissue-Based Products
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Physicians spend a lot of time choosing the correct cellular and tissue-based product (CTP) for their patients. It’s a key focus of patient care: Ensuring that their wound care treatment plan is progressing well and the patient can see marked improvements.
Concurrent to patient care, insurance claims and reimbursement are important for both your clinic and your patients. While selecting the right CTP and checking its availability, it’s also vital to think of the cost implications for your patients. Here are some of the key extras to keep in mind when choosing CTPs.
The Importance Of Medical Necessity
One of the most determining factors in the reimbursement and insurance claim processes deals with the patient’s medical necessity and suitability for the requested treatment. If the treatment is deemed non-essential for the patient during the claim process, this will make it much harder to gain adequate reimbursement. Luckily, improving your case for medical necessity is easy to achieve through extra documentation.
CMS requires, in terms of applications for cellular and tissue-based products, that ‘medical necessity’ for a treatment concerns a wound that has not responded to standard or conventional wound care for thirty consecutive days. Keeping accurate and extensive records documenting the patient’s wound treatment process, non-responsiveness to past medications and compiling this in addition to sufficient charting data allows your clinic to have a stronger stance on the grounds of medical necessity. Good charting is a feature of effective wound diagnosis, and along with competent staff and training sessions, it can drastically reduce the treatment time for your patients. Incorrect diagnosis of a wound can also negatively affect both the treatment and the reimbursement process.
Keep Costs Clear
Costs are a large focus for patients and clinics. Even though it’s only one factor in the overarching treatment of and care for wounds, cost has a major effect on patient stress. It is the clinic’s responsibility to find the right CTP for the patient that also, in most cases, can mean full reimbursement in terms of costs.
Tissue-based skin substitute grafts come in a wide array of prices and cost plans. Always keep in mind the patient’s insurance and co-pay limitations to avoid leaving them in unnecessary debt. While as a physician you may have an excellent cellular and tissue-based product in mind, take the time to check that it will be cost-effective for your clinic and your patient. Products listed and given a code by Medicare do not necessarily mean that full coverage will apply, so take the time to clear up any costs queries that your patient may have before prescribing treatment, whatever insurance company the client is registered with.
Prepare For Audits
As with any medical practice, the prescription of CTPs for wound care is subject to possible audits. This could be due to CMS or Medicare Administrative Contractors (MACs) needing to verify a patient’s true medical necessity, or because there’s been a rise in non-compliant reimbursement applications. Whatever the cause may be, being prepared for an external review will help in the day-to-day running of your practice. If you can stay on top of coding changes and required documentation, the reimbursement process is going to be much simpler.
At CūtisCare, we are experts in the realm of cellular and tissue-based product reimbursement. We’re here to help your hospital or wound clinic focus on what it can do best: helping patients. Our industry knowledge can provide support to our healthcare administration partners, keeping them up to date with current operational and clinical standards. Contact us today and see how partnering with us can help you alleviate your CTP reimbursement concerns.