2012 Financial Outlook: Hospital-Based Outpatient Wound Care Departments

Although the nationally unadjusted average Medicare allowable rates have not increased or decreased significantly, the new codes, the new coding regulations, the NCCI edits, the Medicare contractors' Local Coverage Determinations (LCDs), and the charges that each HOPD sets for each service, procedure, and product may impact the HOPD's revenue in 2012 and 2014. Therefore, every HOPD should take the time to update its charge sheet, its data entry system, and its Charge Description Master database with correct codes, units, and appropriate charges (that account for all the resources needed to perform each service or procedure). The HOPD staff and physicians should carefully read the LCDs that are pertinent to the work that is performed in their facility. If the LCDs contain language that is unclear or incorrect, the HOPD staff and physicians should contact their Medicare contractor medical director and request a revision to the LCD. To be sure that the entire revenue process is working properly, the HOPD should conduct quarterly, if not monthly, audits of their revenue cycle. Medicare has stabilized the HOPD allowable rates for 2012; now the HOPD must do its part to implement the new coding, payment, and coverage regulations. Last, but not least, the HOPD should set up an internal audit program that reviews the entire revenue cycle for all services, procedures, and products. Remember, that which is not measured may not get done correctly or at all. Copyright © 2012.