Due to the ageing of the US population, many of whom have conditions that put them at risk for wounds and necessitate long-term wound care therapy, wound care has taken on increased importance in the healthcare industry.

The difficulty it poses for medical professionals, hospitals, and patients alike is that not all forms of wound care are covered by insurance, and those that are require a number of administrative tasks. These include accurately documenting the medical details of the treatment episode in order to establish insurance eligibility, as well as keeping and providing documentation proving that the treatment was carried out on a doctor’s recommendation and in the doctor’s presence when necessary.

Care providers must first ascertain whether the wound treatment they are requesting reimbursement for is covered by the insurance coverage policy framed by Medicare and Medicaid (CMS) before beginning this laborious process of preparing and submitting claims. This requires knowledge of both insurance coverage and medical necessities.

Using PBC to handle medical billing for wound care

The medical billing and coding team at PBC has extensive experience managing the full gamut of tasks, from figuring out insurance eligibility to filing claims and following up on a regular basis. However, as wound care is a treatment that is provided by independent physicians as well as care providers of all sizes, it can be difficult for care providers to select a billing and coding service model that is sufficiently scalable to meet their needs.

PBC provides two service models : a revenue management consulting methodology and an outsourced billing and coding model :

• Care providers can fully delegate their billing and coding duties to PBC through the outsourced billing and coding services model, freeing up time for medical care instead of administrative tasks.
• On the other side, our revenue management consulting services help streamline internal revenue management by eliminating antiquated procedures, suggesting suitable software to replace the antiquated ones, and identifying potential income leakage and staff training areas to help close them.

Either by streamlining processes and providing staff with thorough training to ensure they fully understand the tasks required to prepare and accurately file insurance claims, minimising the likelihood of claim rejections, or by completely relieving themselves of the responsibility to handle insurance administrative activities themselves, both models have assisted large and small care providers involved in wound care across all US states in overcoming the challenge presented by these administrative activities to claim insurance, improve their revenues, and maximise their internal resources.