Each year, the Centers for Medicare & Medicaid Services (CMS) conducts medical reviews (audits) of Medicare Part A/B, Medicaid, and DMEPOS claims in an effort to help lower improper payment rates and protect the Medicare Trust Fund. The wound management industry has long been under scrutiny since the advent of increased coverage for Hyperbaric Oxygen Therapy (HBOT) services in the late 1990's and early 2000's. In part, that scrutiny has included reviews by the OIG and Medicare audit contractors for wound debridements, skin substitute applications, HBOT, and E/M services. In addition, the OIG added audits of skin substitute grafts to their work plan in November 2024 (OAS-25-09-005) with an expected report issue date of 2026. Audit activity for CY 2026 looks to be a continuation of the same with a focus on determining whether claims follow coverage, coding, payment, and billing requirements.
If you are not conducting self-audits for any of these services, consider using C+ Consulting, a firm with over 30 years of experience in the outpatient wound management industry, for your audit needs. We work closely with our clients to conduct medical record audits and help prepare documentation packets for submission in response to ADRs (Additional Documentation Requests). This assistance includes more than just a review of the denied dates of service, as it is necessary to determine if supporting documentation exists for services provided preceding, during, and post the denied dates. In addition, our presence on calls with the different contractors helps to clarify which documentation is missing as well as the rationale for the denials, which helps when gathering additional documentation for re-review. See our Services page for detailed information on how we can assist you with internal audits, whether your practice is currently being audited or not, and/or appeals.