The Business of Wound Care Adjunctive Income Streams Durable Medical Equipment

Transcription

1 The Business of Wound Care Adjunctive Income Streams Durable Medical Equipment John N. Evans, DPM, FACFAS Chief of Podiatry Beaumont Hospital Dearborn, MI

2 Disclosures Speaker s Bureau: Michigan Podiatric Medical Association Stockholder: none Honorarium: none Grant/Research Support: none Consultant: Avinger PulseFlow Technologies Medical/Scientific Boards: none

3 Durable Medical Equipment (DME)

4 Disclaimer Information provided is to the best of our knowledge and as current as possible. Please verify all policy and reimbursement information with your local DME and Medicare carriers. Cost and reimbursement numbers are approximate and may vary by product and state respectively. Check DME HCSPCS Codes for Surgical Dressings and PDAC Product listings for most appropriate code for product being dispensed

5 Why be a DME Supplier? Patient receives the correct item immediately Better patient education and training Financial benefit

6 Why Not be a DME Supplier? Inventory costs Staff training Myriad Supply choices Insurance rules DME regulations Documentation requirements Reimbursement hassles

7 DMERC Carriers Region A: NHIC Region B: NGS (CGS as of July 1, 2016) Region C: Region D: CGS Noridian

8 DME Items Wound Care Supplies Walking Boots and Braces Diabetic Shoes

9 Wound Supplies are a Covered Benefit under Medicare Part B if: Medically Necessary Caused by or treated by a Surgical procedure When a wound has been Debrided

10 Calcium Alginates Brown seaweed Extremely absorbant Patient must have moderate to heavy drainage (note must reflect this) Cannot be used with hydrogels Available in ropes for filling and flat pads for open wounds Interacts with wound exudate to form a moist gel May use in infected wounds

11 Calcium Alginates A6196, A6197, A6199 Up to 30 pieces per month per wound allowed Cost: $2.25 for small size Reimbursement: $8 Profit: $5.25/each Profit $157.50/mo/wound Example: Algicell, Sorbsan

12 Foams Very absorbant Notes need to reflect moderate to heavy drainage Have film, adhesive or no backing on outer surface Semi-occlusive Filler in dead space Does not adhere to wound bed Not always useful for dry eschar Cannot be used with hydrogels

13 Foams A6209-A6214 Up to 12 pieces per wound month allowed Cost: $1.75 (A6212) Reimbursement: $10.73 Profit: $9 each Profit: $108/mo/wound Example: PolyMem, Allevyn, Hydrofera Blue

14 Collagens Absorbent, conformable and non-adherent Note needs to indicate Mild, moderate, or heavy drainage Available in pads, particles, powders, paste and ribbons/strips Can use in Infected wounds and Tunneling wounds Provides matrix for tissue and vessel growth May be composed of bovine material watch for sensitivities Not recommended for 3 rd degree burns, dry eschar or necrotic wounds

15 Collagens A6010-A6024 A6021 Collagen pad less than 16 sq cm A6010 Collagen powder, per gram A Up to 30 pieces per wound per month allowed Cost: $3.50 Reimbursement: $23 Profit: $19.50 each, or $585/mo/wound Example: Prisma, Promagran, Puracel A6010 Up to 30 gm per wound per month Cost $15 per gram Reimbursement: $34 Profit: $19/gm, or $570/mo/wound Example: Stimulen, Cellerate, Helix 3 Powder

16 Hydrogels Gauze (A6231-A6233) Pads (A6242-A6247) Gel (A6248)

17 Hydrogels Notes need to reflect none to light drainage Available in amorphous gels, sheets, or impregnated in gauze Helps maintain a moist healing environment In gauze form can be used to fill wounds Can use when infection is present w/ topical antibiotics May cause maceration if exudate increases

18 Hydrogel Gauze A pieces per wound per month allowed Cost: $4.20 per piece Reimbursement: $5.18 Profit: $1 each, or $30/mo/wound Example: Amerigel saturated gauze 2x2 inch

19 Calculating Amount of Dressing that can be dispensed per month Alginates- Foams- Collagens- Hydrogels- 30 per wound per month 12 per wound per month 30 per wound per month, or 30gm per wound per month 3oz per wound per month, or 30 pieces per wound per month Hydrocolloids- 12 per wound per month

20 When Not to be a Dressing Supplier Hospice patient Patient enrolled in Home Health Care Your payment will be denied

21 Progress Note Documentation Type of wound, necrotic tissue presence Wound location, Size, and Depth Amount of Drainage Has the wound been Debrided: Method of debridement (scalpel, nippers) Anesthesia used: How much. If not, why? Depth of debridement Partial, Full thickness, SQ, Muscle, Bone Pre and post debridement measurements Dressings applied in office (do not bill for these) Treatment Plan

22 Required Wound Dressing Documentation Date of Service Type of dressing Dressing size Number of dressings dispensed Number of wounds being treated Amount or number of dressings used at a time Frequency of dressing changes Anticipated duration of dressing requirement Type of wound Wound location, Size, and Depth Amount of Drainage Has the wound been Debrided? ***

23 My recommendations for Wound DME: Research your Medicare Carrier LCD Review or attend a lecture or article on the rules for wound care dressing billing Documentation and Billing rules are complicated but important to avoid audit or denial

24 Walking Braces and Wounds L4360/1 (Ambulatory Boot, pneumatic) L4386/7 (Ambulatory Boot, non-pneumatic) If a diagnosis of Diabetes or Ulcer is used, it is a Non-Covered Benefit If the brace is used to treat an Orthopedic condition (instability, Charcot, Deformity, ) it is a Covered Benefit

25 So Long, and Thanks For All the Fish -Douglas Adams

26 The Business of Wound Care Adjunctive Income Streams Durable Medical Equipment John N. Evans, DPM, FACFAS Chief of Podiatry Beaumont Hospital Dearborn, MI