Documentation and reimbursement by clinical setting

Healthcare is a business. As healthcare professionals and clinicians, we must accept this fact. Regulatory issues and reimbursement mechanisms have an enormous impact on the quality of care, the introduction of new technology, utilization of products and services, patient access to care, and the actual outcomes of care delivered. An understanding of these issues is necessary for the wound care clinician who must be adequately reimbursed for his/her services. This Chronic Wound Care Preview gives an overview of Medicare and Medicaid, and reimbursement essentials necessary in the acute care, subacute care, skilled nursing facility and home health care setting. Basic reimbursement tenets, along with wound care documentation guidelines, are discussed. The message is clear: the single, most critical factor to favorable coverage decisions is complete, accurate, and descriptive documentation. It is the clinician's responsibility to educate third-party payers on the cost benefits, safety and efficacy, and positive outcomes of the many treatment and management approaches for wound care.