Reimbursement Readiness

Coding correctly is about more than selecting the right CPT code. Understanding National Correct Coding Initiative (NCCI) edits is essential to avoiding denied claims, preventing compliance issues, and ensuring accurate reimbursement. In this episode of Reimbursement Readiness , Kathleen Schaum welcomes reimbursement expert Yesenia Banks to explain the fundamentals of NCCI edits in practical, easy...

Documentation errors don't just create compliance headaches—they can lead to denied claims, recoupments, and unwanted audit scrutiny. In this episode of Reimbursement Readiness , Kathleen Schaum welcomes reimbursement consultant Donna Cartwright to discuss Medicare's rules for medical record documentation, late entries, addendums, and corrections. Together, they review what auditors look f...

Episode 22 of Reimbursement Readiness: Business Tips for Wound Practice focuses on one of the most overlooked causes of denied claims and repayment demands in wound care: insurance benefit verification . Kathleen Schaum is joined by Amiee Coriano , who explains why verifying more than just “active insurance” is essential before every patient encounter—especially when advanced wound therapies are i...

Episode 21 of Reimbursement Readiness: Business Tips for Wound Practice addresses one of the most common—and costly—sources of claim denials in wound care: Medicare consolidated billing . Kathleen Schaum is joined by reimbursement expert Yesenia Banks , who explains why many wound care stakeholders only learn about consolidated billing after claims are denied or payments are recouped. In this epis...

Episode 20 of Reimbursement Readiness: Business Tips for Wound Practice delivers a timely field report on the WISER Prior Authorization Program —based on real, early experiences from stakeholders submitting requests in New Jersey, Ohio, Oklahoma, and Texas . Even listeners outside the participating states asked for this update, because the “why” behind approvals and denials is helping teams everyw...

Episode 19 of Reimbursement Readiness: Business Tips for Wound Practice tackles the surge of reimbursement questions surrounding autologous platelet-rich plasma (PRP) and other blood-derived products for diabetic chronic wounds. After the 2026 OPPS and Physician Fee Schedule changes, many outpatient departments and physician practices are evaluating whether and how to add PRP/blood-derived technol...

Send us your feedback: Audience Survey ------ In Episode 18 of Reimbursement Readiness: Business Tips for Wound Practice , Kathleen Schaum welcomes reimbursement expert Donna Cartwright to tackle the flood of physician questions surrounding the 2026 CTP payment changes. With misinformation circulating widely, this episode focuses on what CMS has actually finalized—and what physicians need to opera...

As 2026 begins, Kathleen Schaum opens Episode 17 of Reimbursement Readiness: Business Tips for Wound Practice with a candid assessment of the turbulence wound care teams endured in 2025—particularly around cellular and tissue-based products (CTPs). While the 2026 Medicare Outpatient Prospective Payment System (OPPS) Final Rule brought meaningful improvements for hospital-owned outpatient provider-...

In Episode 16 of Reimbursement Readiness: Business Tips for Wound Practice , Kathleen Schaum addresses one of the most frequently misunderstood topics in Medicare reimbursement: Incident-to billing . Drawing from common questions submitted by Wound Care Today USA subscribers—and recurring errors seen in real-world consulting—this episode is designed to clarify what Incident-to billing truly is, wh...

In Episode 15, Kathleen Schaum and Amiee Coriano walk Wound Care Today USA subscribers through CMS’s new WISeR Model , a national initiative designed to reduce fraud, waste, and abuse by applying prior authorization and enhanced medical review to select services in traditional Medicare. While the 2026 payment rules for CTPs are now known, this episode underscores a critical point for every revenue...

Kathleen welcomes Yesenia Banks to break down Medicare’s 2026 Final Rule for Home Health Agencies and DME suppliers , rounding out the series on year-ahead payment policy. Yesenia explains the Patient-Driven Groupings Model (PDGM) —how 30-day periods, admission source/timing, clinical groupings (including wounds), functional status, and comorbidity adjustments combine into case-mix weights and pay...

Kathleen walks hospital-owned outpatient wound and ulcer management teams through the OPPS Final Rule for 2026 , clarifying how CMS turns policy into payment via APC groupings and where to locate the official national rates in Addendum A (by APC) and Addendum B (by HCPCS) . She details the headline changes for CTPs: unpackaging products from the application procedures, eliminating high/low cost ti...

In Episode 12 of Reimbursement Readiness: Business Tips for Wound Practice , Kathleen Schaum unpacks the 2026 Medicare Physician Fee Schedule (MPFS) Final Rule —a document that determines how physicians and qualified healthcare professionals (QHPs) will be paid in the coming year. She explains how this 2,000-page rule shapes the final payment policies for services, procedures, and products, and hi...

Reimbursement expert Kathleen D. Schaum, M.S. and Jeremy Bowden , President of WCT USA , break down the CY 2026 Medicare PFS Final Rule's bombshell changes to skin substitutes and CTPs! The Big Change: CMS is completely overhauling how skin substitutes are paid—moving from ASP-based methodology to incident-to supplies with product-category payment grouping. The Numbers That Matter: Part B spen...

In Episode 11 of Reimbursement Readiness: Business Tips for Wound Practice , Kathleen Schaum welcomes back Amiee Coriano , CEO of AMC Medical Consulting , for an in-depth discussion on contracting with commercial and private payers . Amiee explains the critical differences between credentialing and contracting , then walks through the essential elements every provider should understand before sign...

Great News About the CMS Claims Hold! On October 15, 2025 Kathleen Schaum shared some bad news that was going to affect the cash flow of all professionals paid by the Medicare Physician Fee Schedule. Now on October 17, 2025 listen to Kathleen explain the breaking great news about the CMS Claims Hold. 

In Episode 10 of Reimbursement Readiness , Kathleen Schaum welcomes listeners back and reintroduces her guest, Amiee Coriano, CEO of AMC Medical Consultant. Kathleen highlights Amiee’s expertise in wound and ulcer management, coding, and billing, and sets the stage for another practical discussion on navigating reimbursement challenges in wound care. This episode continues the conversation with Am...

If you are paid according to the Medicare Physician Fee Schedule, CMS has indefinitely extended the hold on your payment. Listen to host of Reimbursement Readiness Kathleen D. Schaum, M.S.explain this breaking news.

In Episode 9 of Reimbursement Readiness , Kathleen Schaum welcomes listeners back and reviews the progress made so far in understanding coverage policies, ICD-10-CM diagnosis codes, and ulcer classification. To continue the journey, she introduces a new guest expert who joins to share her insights on reimbursement and coding in wound care practice. This episode features special guest Amiee Coriano...

In this episode, Donna Cartwright walks providers through the newly released ICD-10-CM diagnosis codes for wound and ulcer management, effective October 1st. She explains what has changed, why these updates matter for clinical practice, and how to apply them correctly in documentation and reimbursement. Listeners will gain clarity on the latest code additions, adjustments, and practical strategies...

In Episode 7 of Reimbursement Readiness: Business Tips for Wound Practice , Donna Cartwright joins Kathleen Schaum to tackle one of the most frequently asked questions in wound care coding: When should you report a wound or when should you report an ulcer? Donna breaks down the distinctions between acute wounds and chronic ulcers, covering examples from lacerations, burns, and surgical complicatio...

In this episode, Donna Cartwright explains why it’s critical to match ICD-10-CM diagnosis codes with the appropriate procedure codes outlined in Medicare’s Local Coverage Determinations (LCDs) and Local Coding and Billing Articles (LCAs). She breaks down six key reasons these code lists matter—from ensuring medical necessity and preventing improper payments to minimizing denials, reducing audit ri...

Episode 05 – Specific Diagnosis Coding Instructions for Venous Ulcers In Episode 5 of Reimbursement Readiness: Business Tips for Wound Practice, expert Donna Cartwright returns to guide wound care professionals through ICD-10-CM coding for venous ulcers. This in-depth episode covers: Key coding terms in the Alphabetic Index: atherosclerosis, varicose veins, post-thrombotic syndrome, and chronic ve...

Episode 04 – Specific Diagnosis Coding Instructions In Episode 4 of Reimbursement Readiness, Donna Cartwright dives deep into ICD-10-CM diagnosis coding for diabetic ulcers. She walks listeners through using the Alphabetic and Tabular Indexes, explains how to apply combination coding with ulcer severity, and highlights important coding notes such as “code first” and “use additional code.” You'...

NEWS FLASH: Major Medicare Proposed Rule Changes Affecting CTPs 7/23/2025 – CMS recently released proposed 2026 changes to the Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (HOPPS)—including a major shift in reimbursement for cellular and/or tissue-based products (CTPs). In this Reimbursement Readiness News Flash , expert Kathleen Schaum breaks down what providers...