Medicare covers many products and services that are needed to manage chronic wounds. However, Medicare does not always cover the products for all indications, at the frequency that physician or the patient would like, etc. When a wound care clinic and/or practitioner believes that Medicare covers the product of service, but does not believe Medicare will cover it for a particular patient, that patient should be given an Advanced Beneficiary Notice (ABN). In addition, if a product or service, the practitioner is required to give the patient an ABN prior to treatment. If the patient is not given an ABN, and Medicare denies coverage of the product or service, the clinic and/or practitioner cannot collect payment from the patient. To help readers understand the new Medicare ABN, I interviewed Donna Cartwright, MPH, RHIA, CCS, RAC, one of new editorial board members for Today’s Wound Clinic. Donna is a professional coder who brings over 27 years … read more
Tag: Kathleen D. Schaum
Why Is Debridement Coding Such a Mystery?
Kathleen D. Schaum, MS
At the 3-hour Symposium on Advanced Wound Care (SAWC) Spring reimbursement post-conference, this author/speaker prepared more than 40 interactive coding, payment, and coverage scenarios for the attendees to assess their knowledge. The topics of the scenarios were carefully selected and included a balance of coding for frequently performed services, coding that is typically denied or recouped upon audits, coding and payment for new services and procedures, and new coding, coverage, and payment for new procedures … Surprisingly, the attendees spent the most time asking questions about a topic that should be well-known and understood by all wound/ulcer management physicians and other qualified healthcare professionals (QHPs): coding and payment for debridement … read more
Alphabet Soup of Codes for CTPs [Skin Substitutes] for Skin Wounds
Kathleen D. Schaum, MS
As a reimbursement strategy and education consultant, this author always attempts to explain the reimbursement “who?” “what?” and “why?” in an easy-to-understand manner. Because readers have submitted many questions about the diverse types of HCPCS codes recently assigned to cellular- and/or tissue-based products (CTPs) for skin wounds [outdated term “skin substitute”], this article will address the “who?” and “what?” However, the article will not address the “why?” because the Centers for Medicare & Medicaid Services (CMS) have not explained “why” they assigned diverse types of HCPCS codes to the CTPs … read more
Latest Medicare Payment Updates for Physicians and Other Qualified Healthcare Professionals
Many readers ask this author “why don’t you publish Medicare payment information immediately after the Medicare Physician Fee Schedule (MPFS) Final Rule is released?” Actually, this author used to publish MPFS payment changes right after the release of the Final Rule. Unfortunately, the Final Rule is not always final. For the last few decades, significant changes have always been made after the Final Rule was released … read more
Help support non-profit medical journalism. If you find WoundCareWeekly.com of value please consider a monthly donation to help cover expenses and keep this website going.
What Is the Difference Between RPM and RTM?
Ever since the CPT® 2022 codebook was released by the American Medical Association, this author has received many calls and e-mails from wound/ulcer management professionals and providers inquiring about the similarities and differences between the 5 new remote therapeutic monitoring (RTM) services codes and the 5 remote physiologic monitoring (RPM) services codes that were created in 2019. Therapists were particularly eager to learn about the new RTM codes and rules. Therefore, this author created the following table, which displays the frequently asked questions and the side-by-side comparison of the answers as they pertain to RPM and RTM … read more
Have You Revised Your EHR Screens/Templates and Charging System?
At the 2021 SAWC Fall a team (medical director, program director, and clinical nurse manager) from a hospital owned outpatient wound/ulcer management provider-based department (PBD) asked many questions after my main session reimbursement presentation and during my interactive reimbursement session post-conference … When I returned to my office the next week, this same team called me and requested teleconsultation services as soon as possible … As a reimbursement consultant … read more
LinkedIn:
Kathleen D. Schaum
Today’s Wound Clinic