Best Practices for Handling Wound Care Billing

Proper reimbursement for wound care can be a complex process due to the various factors it involves – type of wound, the services provided, the healthcare setting and the insurance coverage of the patient.

Here are some general guidelines to help your medical practice bill for wound care properly.

  • Accurately document the wound care, including the medical necessity of the service(s)

  • Thoroughly document wound characteristics (be specific)

    • Size, depth, location and stage of wound

    • Any complications

    • Any comorbidities or underlying medical conditions that may impact wound healing or treatment decisions

    • Wound care plan – type of dressings, treatments and frequency

  • Assign the appropriate code(s) to indicate reason or the wound care

  • Use terminology or codes to describe the specific wound care procedures performed. Codes may include debridement, wound assessment, application of dressing and other related services.

  • Verify patient eligibility and benefits before providing wound care to ensure coverage.

  • Familiarize yourself with the guidelines and policies of a patient’s insurance plan, as different insurance companies may have specific requirements for wound care billing.

  • Promptly submit claims for wound care services to avoid claim denials due to billing deadlines.

  • Understand the reimbursement rates for wound care services in your area and by various payers. Different insurance plans and government programs may offer different reimbursement levels.

  • If a claim is denied, follow the appeal process of the payer. Often, a claim can be successfully appealed with additional documentation and clarification

Processing wound claims correctly is essential to a healthy revenue cycle. Outsourcing may be an attractive solution, as you can align your medical practice with a resource that is well versed at wound care billing. In doing so inaccuracies or complications that lead to delayed payment/denied claims can be avoided. This will not only benefit your bottom line, but also free up time for your practice to focus even more on patient care.

David Swiercz