Wound Care billing and accounts receivable

Wound care runs on debridement, skin substitute application, compression for venous ulcers and hyperbaric therapy, and the claim is built out of what the note records: the tissue removed, the measurements taken, the product used. The same wound is billed visit after visit for months, so each claim has to show what changed since the last one.

Where the money leaks in wound care

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Debridement billed at a depth the note does not support, because the description names slough and fibrin rather than the deepest tissue actually removed
• No wound measurements taken before and after the debridement, so the surface area of tissue removed, which the units were billed from, cannot be traced
• Skin substitute applied without the chart showing which conservative treatments were tried and over what period they failed to close the wound
• Discarded product not documented against the package opened, so the units billed cannot be reconciled with the wound area treated and the size supplied
• Hyperbaric sessions billed from a note that calls the wound non-healing but does not grade the diabetic foot ulcer, list the standard care that failed first, or record chamber time
• Serial debridements denied as repetitive when consecutive notes carry identical measurements and the same tissue description copied forward

What a seat does about it

One trained person works your queue from the difficult end, from our office in Rawalpindi, Pakistan, logged into your own system on your hours. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing. Some payer contracts and some state Medicaid programs restrict or require disclosure of offshore access — check yours before placing a restricted queue on this seat (more on /security/).

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and medical coding at $2,500, on request.

Questions