Wound care billing can play a trick of looking simple but then hiding the complexity of documentation and changing regulations, that popup anytime. Recently at Legion healthcare solutions (LHS) we experienced that physicians who had used modifier 25 had to face further scrutiny, where more documentation were called in and even in some cases the part payment was done. So how does one manage such scrutiny that completely changes the claim process, the answer is documentation.

Legion believes that documentation is what supports the clinical substance where judgments and decisions making can be described.

“Wound care billing has been exciting for Legion because everyday a new patient comes in and then we have to process their claims that are completely different. We have to continuously support the documentation because audit is one thing we have seen several times in wound care billing. Even with many of our guidelines in place wound care physicians miss several things, hence we have to communicate with patients many times”

- Account Manager for Wound care billing

Wound care billing works with specificity, so every procedure performed needs to be captured in documents. Legion has been working on wound care billing for more than a decade and our experts have over 30 years of experience, let’s understand what makes us so unique:

Coding, Coding, and Coding

Wound care coding is considered one of the most challenging because with other specialties once the procedure is coded we are sure to be getting paid. However, with wound care, we usually have to turn towards rules under which the procedure is performed and under that, it must be operated. Legion deploys a team of certified coders and documentation experts who work daily with wound care physicians making sure, each wound care claim has the right code based on the procedure.

Documenting for Debridement

11042 and 11045 for subcutaneous tissue, 11043 and 11046 for muscle and fascia, 11044 and 11047 for bones. Defining debridement of tissue or bone can be a challenge and once any of the initial aspects are not covered documentation becomes a challenge. Legion has a set of guidelines to guide the physicians in such cases, which covers all the required points for billing.

Dashboard for Claim Management

Legion keeps a continuous tab of each of our claims, once the documentation process is over our team of coding and billing experts audits the claim. Once the claim is audited it’s sent to an insurance company (payer). To make physicians see how the claim is moving they can login to the dashboard and watch over each claim.

Certified team of billers and coders available 24/7.

EHR solutions for all woodcare billing needs.

Denial management dashboard to cover the 360-degree view of reasons and AR days.

Continuous monitoring of each physician claims to keep AR days below 90.

API-and RPM-based solution for improved patient care.