Reimbursement Readiness

Business Tip for all types of wound practices. Hosted by Kathleen D. Schaum and Friends.

Reimbursement Readiness is a health podcast hosted by Wound Care Today USA, with 35 episodes on record and a Required Pod Score of 80. PitchCentric scores this show on Booking Probability, Listen Score, and live audience signals refreshed every 24 hours.

Wound Care Today USA hosts Reimbursement Readiness, a health show with 35 episodes published.

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  Episode #29

  Ep.29 Plan of Care and Progress Notes

  Sep 17, 202614 minS1

  In Episode 29 of Reimbursement Readiness: Business Tips for Wound Practice , Kathleen Schaum and Donna Cartwright continue the Wound and Ulcer Management Audit Readiness Series with Part 3, focusing on two of the most important components of the medical record: the plan of care and progress notes. Donna explains how a comprehensive plan of care supports medical necessity, communicates treatment goals, tracks changes over time, and helps auditors understand why specific services, procedures, and products were selected. She also reviews what should be documented for each wound or ulcer, including measurable goals, expected outcomes, barriers to healing, prior treatments, patient instructions, coordination with other clinicians, and changes made when treatment is not progressing as expected. The episode also takes a closer look at progress notes and how they should tell the ongoing story of each wound—from prior treatment results and clinical decision-making to measurements, wound appearance, signs of infection, overall assessment, and next steps. By keeping documentation consistent and showing how the patient is progressing from one encounter to the next, wound care teams can strengthen medical necessity and better prepare for payer audits. Downloads Plan of Care and Progress Notes Checklist Episode Survey Click Here

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  Episode #28

  Ep.28 Select CPT and HCPCS Codes Based on their Code Descriptions

  Sep 3, 202619 minS1

  Episode Survey In Episode 28 of Reimbursement Readiness: Business Tips for Wound Practice , Kathleen Schaum turns the focus to a fundamental but often overlooked part of reimbursement: understanding the full descriptions behind CPT and HCPCS codes. As denials and audit failures continue to expose gaps between documentation and reported codes, Kathleen explains why knowing the code number alone is not enough. Using examples from debridement, CTP applications, autologous blood-derived products, negative pressure wound therapy, and wound care products, Kathleen breaks down the three key components of a code description: the service or product being identified, the clarifying information that defines its use, and the unit or measurement tied to reporting. She also highlights how seemingly similar codes can differ significantly based on anatomy, wound type, treatment method, or unit of measure. The episode reinforces one central principle: the documentation in the medical record must align with the code description reported on the claim. Kathleen also encourages clinicians, coders, and billers to review the codes they use most often, update their systems and workflows as needed, and use the provided checklist to strengthen coding accuracy and reduce denials, repayments, and compliance risk. Handout: Checklist for Selecting Wound and Ulcer Management Codes Based on Their Code Descriptions

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  Episode #27

  Ep.27 Wound Description and Measurements

  Aug 20, 202617 minS1

  In Episode 27 of Reimbursement Readiness: Business Tips for Wound Practice , Kathleen Schaum and Donna Cartwright continue the Wound and Ulcer Management Audit Readiness Series with Part 2, focusing on wound and ulcer measurements and descriptions. Accurate documentation in these areas is essential not only for clinical continuity, but also for demonstrating medical necessity and supporting reimbursement during pre- and post-payment audits. Donna explains what auditors expect to see in the medical record, including consistent wound measurements, clear documentation of changes over time, complete descriptions of each wound’s origin and condition, and the results of previous treatments. She also reviews common documentation problems that can lead to denials or repayments, such as mismatched wound descriptions, missing post-procedure measurements, incomplete tissue percentages, unsupported treatment continuation, and incorrect CTP sizing or wastage reporting. The episode closes with practical guidance for conducting an internal self-audit and improving documentation workflows. Donna also provides a checklist that wound care teams can use to evaluate whether their wound measurements and descriptions clearly tell the story of each wound and support the medical necessity of the care provided. Episode 27 Evaluation Link: CLICK HERE DOWNLOADS: Checklist for Measurements and Wound Description

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  Episode #25

  Ep.25 Audit Readiness - PART 1

  Jul 23, 202616 minS1

  In Episode 25 of Reimbursement Readiness: Business Tips for Wound Practice , Kathleen Schaum and Donna Cartwright launch a new Wound and Ulcer Management Audit Readiness series focused on the documentation auditors expect to find in the medical record. This first installment examines the history and physical, showing how incomplete, inconsistent, or overly broad documentation can undermine medical necessity and place reimbursement at risk. Donna explains how to make each record self-contained, clearly identify the origin and location of every wound, document prior treatments and their effectiveness, and connect underlying conditions to the patient’s ability to heal. She also addresses common audit concerns such as inconsistent wound counts, contradictory physical-exam findings, missing results from previous therapies, and cloned or outdated information pulled forward by the electronic health record. Listeners will also receive a practical checklist they can use to self-audit their own history and physical documentation. The goal is simple: help the auditor understand the patient’s condition, the progression of each wound, and why the selected treatment was medically necessary. Download History & Physical Checklist

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  Reimbursement Readiness

  NEWS FLASH: 2027 OPPS and MPFSP Proposed Rules

  Jul 15, 202612 minS1

  The 2027 OPPS and MPFS proposed rules are here. Sheet CTPs hold steady, non-sheet CTPs move to a size-based payment model, ABDP rates rise in OPPS only, and SCSA gets a whole new coding structure. Comments due August 31 (OPPS) and September 14 (MPFS). Watch for full update and view links below. 2027 Proposed Rule for Medicare Physician Fee Schedule (MPFS): https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1848-p 2027 Medicare Proposed Rule for Outpatient Prospective Payment System (OPPS): https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1850-p

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