A Self-Checklist of Medicare Reimbursement Basics

Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.

Because Today’s Wound Clinic is focusing on wound/ulcer assessments this month, this author is reminding all readers to remember important Medicare reimbursement basics when you are developing each patient’s plan of care, documenting your work, and submitting your claims to the Medicare Administrative Contractor (MAC) that processes your Medicare claims. This author realizes that all wound/ulcer management professionals and providers have been working under stressful conditions for the past 1½ years and are under some Medicare waivers that may/may not end soon. You also may not have had the time to keep up with the many coding, coverage, and payment changes that have occurred during this unprecedented time.

Therefore, before the 2022 code and payment changes are announced and implemented, all readers should conduct a 2021 self-check to ensure that the required assessments are completed, appropriately documented, and accurately coded for the work performed for your Medicare beneficiaries. To assist you with this important project, this author has compiled a self-checklist that you can use. See Table 1 or click here to download a PDF of this entire article.

Review the self-checklist carefully and honestly. If you are not 100% certain that you know and understand the current regulations and/or guidelines about an item(s) on the checklist, develop and implement a plan to improve your knowledge about the item(s). You cannot afford to get further behind. Many reimbursement resources are available, e.g., books, journals, webinars, coverage policies and articles, seminars, and so forth. Because most of the items on the checklist have been covered in one or more of this author’s Business Briefs columns, Today’s Wound Clinic recently released a list of all these reimbursement-related articles published for the past 14 years. You may want to peruse the list to locate information that pertains to your specific knowledge gaps.

Please keep in mind that everyone has a vested interest in keeping the Medicare Trust Fund solvent and in preventing its abuse. To make that happen, everyone must perform the correct work for their patients, document its medical necessity, and code it right on the Medicare claims. You may not realize that the MACs are part of your revenue cycle team. The MACs are paid to create medical policies and coding articles, to educate the professionals and providers, and to correctly process and pay the claims for medically necessary services, procedures, and products. This author has been impressed with the volumes of reimbursement material that the MACs produce and disseminate. Contrary to popular belief, the MACs are evaluated for their work and are audited for their claim processing performance. Therefore, it is in their best interest that wound/ulcer management professionals and providers correctly document and code, so the MACs pay you correctly the first time and do not have to take repayments during required audits. Do yourself a big favor and take the time to learn this year’s coding, payment, and coverage regulations and guidelines so you are not overwhelmed when the 2022 changes and updates occur.

Look for articles addressing the 2022 coding, payment, and coverage changes that will appear in Today’s Wound Clinic over the next 6 months.

If you have any questions about items on the self-checklist, feel free to reach out to this author at kathleendschaum@bellsouth.net.

Kathleen D. Schaum is a founding member of the Today’s Wound Clinic editorial advisory board and oversees a consulting business. She can be reached for consultation and questions by emailing kathleendschaum@bellsouth.net.

Reference

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