Reimbursement

Medicare and other third-party payers provide reimbursement for KollagenTM wound care products. HBS believes that a clear understanding of Medicare's documentation requirements will help clinicians better meet patient needs. Government policies often influence the reimbursement guidelines of HMOs and other third-party payers. The following information provides Medicare's reimbursement policies and guidelines affecting Medifil® II and SkinTemp® II use.

Physician Guidelines

Purpose:

To deliver appropriate care based upon established and developing medical standards that achieve desired outcomes.

  • Assess the wound.
  • Use the appropriate KollagenTM product based on wound assessment.
  • Know the wound types eligible for reimbursement: all types of debrided wounds, staged wounds, surgically created wounds.
  • Provide a Certificate of Medical Necessity.
  • Monitor the patient and evaluate wound progress.
  • Reassess the wound over time.

Supplier Guidelines

Purpose:

To deliver professional services in strict compliance with specific payer guidelines.

  • Test documentation for Medicare and/or third-party payer eligibility for all product orders.
  • Follow Medicare coding guidelines.
  • Understand and exercise Medicare coverage and payment rules.
  • Comply with Medicare guidelines for delivery and product support to patient.
  • Provide support to patient with the paperwork required to process and submit claims.
  • Submit claim to payer for reimbursement.
  • Repeat guideline process for renewal orders.

Obtaining Medicare Reimbursement

Provider / Supplier:

  • Review and understand DMERC Surgical Dressing Medical Policies and all updates.
  • Verify that the patient file includes the following information to document medical necessity:

    1. Number, size, type, and stage of wounds being treated.
    2. If debrided, the method of debridement used.
    3. State if use is for a primary or secondary dressing.
    4. All clinical information supporting the reasonableness and necessity of surgical dressing type and quantity.
    5. Wound evaluation on at least a monthly basis.
    6. Written confirmation of the physician's supply order.
  • Keep record of source and date of medical necessity information for review or audit when necessary.
  • Consider developing an internal Certificate of Medical Information.
  • Submit claim with following information:

    1. Number of wounds.
    2. Statement about response to previous treatment if other treatments have been prescribed.
    3. Evaluation period (10, 15, 30 days) for collagen dressing.
    4. Manufacturer's name (Human BioSciences, Inc.).
    5. Product name, product size and product number (Medifil® II particles, 5 ml, MF 1010).
    6. Statement that the product is used as a primary dressing, is medically necessary, and improvement is expected by using collagen dressings.

Medifil® II

Available Size: 1gm Vials and 1gm Pouches

HCPCS Code: A6010

SkinTemp® II

Available Size: 2”x2”, 3”x4”, and 8”x12” Sheets

HCPCS Code: A6021/A6022/A6023

Collatek®

Available Size: 30gm/1oz Tubes

HCPCS Code: A6011