Photodocumentation reverses Medicare reimbursement denial

The need for documentation of medical necessity is critical as payors review claims. In the case study described, because the patient exhausted benefits for in-patient treatment under Medicare, rehospitalization would have been without reimbursement. Despite her complex illness and wounds which would normally require hospitalization, the patient was presented to a home health group for interim management. Medicare, the payor in this case, initially denied payment of the claim, questioning the justification for the wound care products used. The home health agency submitted with the denial appeal the most objective documentation available, the serial photographs which clearly indicated positive outcomes. This photodocumentation led to a complete reversal of Medicare's denial and no further denial was received. Photodocumentation should be a part of a standard protocol for documentation of complex wound care.