The MIPS quality menu was built mostly around primary care, cardiology, and other specialties with large, relatively uniform patient populations. A wound center treats someone else: a 60-something patient with a six-month-old wound and six comorbidities. When the...
A hospital outpatient wound center sits in an odd spot under MIPS. The facility is paid under the hospital outpatient system, but the physicians and advanced practice providers who treat patients there are scored as MIPS clinicians, and the payment adjustment lands on...
A local coverage determination (LCD) is the regional Medicare policy that decides whether your debridement or skin substitute application gets paid, and it can differ depending on which Medicare Administrative Contractor (MAC) covers your state. For a wound care...
Every wound clinician knows the frustration: you spend your day debriding osteomyelitis-complicated diabetic foot ulcers on patients with peripheral artery disease, dialysis dependence, and uncontrolled A1c, then get scored on quality measures that assume a healthier,...
Medicare claims data drives more of your MIPS score and coverage future than most wound care clinicians realize, but it was never built to capture what actually happens to a diabetic foot ulcer over six months of treatment. It was built to process payment, not to...
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