Outpatient Wound Care Billing - PowerPoint PPT Presentation

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Outpatient Wound Care Billing


Outpatient wound care center facility reimbursement for Medicare beneficiaries is defined by the Centers for Medicare and Medicaid Services. – PowerPoint PPT presentation

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Title: Outpatient Wound Care Billing

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Outpatient Wound Care Billing
When providers need outpatient wound care
billing, CPT code 11043, 11046, and 11044, 11047
may only be billed in place of service inpatient
hospital, outpatient hospital, or ambulatory
surgical center (ASC). Outpatient wound care is
often considered early discharge of patients from
the acute care setting to the home care setting
and surgical wound care will be delivered by
patients, family members, and home health care
providers instead of the hospital nurse in a
traditional in-patient setting. Currently wound
healing is an evolving specialty with wound care
practitioners facing many challenges, including
rising healthcare costs and difficulties in
ensuring access to and quality of care and all
these challenges can easily be addressed by the
outpatient wound care model by streamlining safe,
cost-effective, and easily accessible care for
patients. Lowers Overall Healthcare Cost An
outpatient wound healing center lowers overall
healthcare costs as it requires less overhead
expenses which reduces costs dramatically. By
centralizing all wound care services under one
roof, without the size and space required by a
hospital, the costs more accurately reflect the
services and procedures for which the patient is
Outpatient Wound Care Billing
Since the outpatient facility is generally
smaller, the staff is reduced and the result is
more cost-effective wound treatment for the
patient. Moreover, in an outpatient center, it is
expected that one expert physician oversees all
treatment and the patient receives seamless care
at each visit, thereby ensuring complete
continuity of care. However, it is not an easy
task, providers need to be cautious while
transitioning patients to outpatient wound
care facilities. Lets understand in more
detail   Important factors for transitioning
from inpatient to outpatient wound care You need
to consider various factors like overall health,
access to services, severity, and complexity of
the wound, and equipment availability while
transitioning a patient from inpatient to
outpatient care and during care transition
treatment you should use modalities to maintain
continuous care. For outpatient wound care, NPWT
use was recommended for the removal of infectious
materials and exudate management. Moreover,
dressings like The ORC/C/silver-ORC may be used
to help manage exudate and promote granulation
tissue development and moist wound healing.
Outpatient Wound Care Billing
Now you have equipped with outpatient wound care
information, now you need to be aware of its
billing. Lets discuss in more detail Outpatient
Wound Care Billing When patients are seen by a
QHP (Qualified Healthcare professionals) in an
HOPD, the patients and Medicare receive two
bills one from the HOPD and one from the QHP
while when patients are seen by a QHP in his or
her office, the patients and Medicare only
receive one bill. Bill Type Codes Contractors
may specify Bill Types to help providers identify
those Bill Types typically used to report service.
Outpatient Wound Care Billing
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
018x Hospital Swing Beds
022x Skilled Nursing Inpatient (Medicare Part B only)
023x Skilled Nursing Outpatient
071x Clinic Rural Health
073x Clinic Freestanding
074x Clinic Outpatient Rehabilitation Facility (ORF)
075x Clinic Comprehensive Outpatient Rehabilitation Facility (CORF)
Outpatient Wound Care Billing
It is observed that MACs may update LCDs as
often as they deem necessary hence wound care
professionals should assign someone to review
LCDs every month. When LCDs are revised, all
wound care professionals should read them
carefully. The trend in health care seems to be
moving away from hospital-based wound care to the
more centralized outpatient wound care models
that have benefited patients in the areas of
intravenous antibiotics and now in wound
management. You can outsource your wound care
billing, we can help you to increase your overall
collection. We are a HIPAA compliant leading
medical billing company. To know more about our
Wound Care billing and coding services, contact
us at info_at_medicalbillersandcoders.com/888-357-322
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