Handling the Changing Reimbursement Scene

Kathleen D. Schaum, MS

In the November issue of OWM, Kathleen D, Schaum, President and Founder of Kathleen D. Schaum & Associates, Inc, Lake Worth, FL, and a 50-year veteran of reimbursement issues, addressed recent changes to reimbursement policies that will impact wound care providers as part of the new value-based system. Here, she further outlines strategies she anticipates will become part of her, and your, wound care scenarios. Ms. Schaum can be reached for questions and consultations at 561-964-2470 or through her email address: kathleendschaum@bellsouth.net.

Here are the most typical consultation projects this reimbursement strategy consultant handles in the volume-based model and the value-based model of wound care.

Volume-based reimbursement strategy projects.

For providers:

  • Reviewing Charge Description Master to be sure wound care professionals are appropriately billing for the work they perform
  • Comparing charges versus actual claims submitted versus actual payment and co-payment received
  • Reviewing LCDs and private payer medical policies pertinent to wound care professionals

For manufacturers:

  • Educating executives how their products/procedures are paid in the sites of care where they intend to focus marketing and sales
  • Educating executives about the pathways to coding, payment, and coverage for new products and procedures
  • Educating sales representatives how their products and procedures should be coded, how they will be paid, and how they will be covered throughout the continuum of care

Value-based reimbursement strategy projects

For providers:

  • Educating wound care professionals on how all providers in their health system are paid
  • Educating about need to report wound care quality measures through registries
  • Educating on how wound care professionals should adapt to their shared savings program, their risk-sharing contracts, their bundled payment etc.  programs, etc.
  • Educating on how to balance volume-based payments with value-based payments, programs, and contracts

For manufacturers:

  • Educating executives about the need to include health economic studies in their pathway to coding, payment, and coverage of new products and procedures
  • Educating executives about the value of collecting data through wound care registries
  • Educating executives about the need to prepare for new types of contracting with shared savings programs, risk-sharing programs, bundled payment programs, etc.
  • Educating the sales force on how to position products and procedures in value-based payment systems.

Knowledge is a beautiful thing. Now is the time to reach out to reimbursement specialists who can educate you and your colleagues on wound care reimbursement coding, payment, and coverage changes that are impacting how professionals provide wound care and how manufacturers position their wound care products and procedures in the marketplace.