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.
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Verify that the patient file includes the following information to document medical necessity:
- Number, size, type, and stage of wounds being treated.
- If debrided, the method of debridement used.
- State if use is for a primary or secondary dressing.
- All clinical information supporting the reasonableness and necessity of surgical dressing type and quantity.
- Wound evaluation on at least a monthly basis.
- 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.
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Submit claim with following information:
- Number of wounds.
- Statement about response to previous treatment if other treatments have been prescribed.
- Evaluation period (10, 15, 30 days) for collagen dressing.
- Manufacturer's name (Human BioSciences, Inc.).
- Product name, product size and product number (Medifil® II particles, 5 ml, MF 1010).
- 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
