How Can Wound Care RCM Build a Denial-Proof Revenue Cycle?
Summary:** Wound care revenue cycle management (RCM) faces unique challenges like variable payer rules, documentation gaps, and denials (30-50% for DFUs), but real-time analytics can cut AR by 40% by tracking patterns, automating appeals, and ensuring compliance. MBC’s dashboard monitors denial reasons (e.g., medical necessity for grafts), provider delays, and CPT coding, with outsourcing offering expertise in modifiers and prior auths to boost collections and reduce write-offs in chronic ulcer billing.
Key Highlights:
- Challenges: 40% denials from poor documentation; variable coverage for biologics.
- Analytics: Tracks AR buckets, denial codes, payer trends for proactive fixes.
- Strategies: Automated appeals, coder training, payer-specific guidelines.
- Outcomes: 42% AR reduction in client; 95% first-pass claims.
- Outsourcing: MBC provides end-to-end for wound care, including audits.
Keywords: wound care RCM, denial management, AR reduction, CPT coding, ulcer billing