Reimbursement challenges and how to meet them.

How we deliver healthcare in the U.S., and how that care is paid for, is evolving. Reimbursement and payment issues now directly impact patient care and clinical decisions. Comprehensive documentation is essential to receiving reimbursement. Therapeutic positioning used by therapists is considered a skilled service. The key to Medicare reimbursement for therapeutic positioning and other services is documentation which clearly outlines the required skills of the professional, the medical necessity and reasonableness of the service, and the significant functional and safety goals that have been met, along with the progress over time. Medicare coverage and payment policies for surgical dressings and support surfaces have been revised in the last few years. The current surgical dressings policy has a number of points that must be understood: X1 modifiers, border versus non-border dressings, wound fillers and covers, solutions (saline), wound fillers (amorphous), dressing kits, staging, sterile versus non-sterile gauze, and normal utilization parameters. Many restrictions in both surgical dressings and support surfaces policies are efforts to curb fraud and abuse. The future of reimbursement depends of the involvement of healthcare professionals by developing research-based protocols, comprehensive documentation, education of both peers and patients, and political empowerment.