As a high-performing and successful podiatrist, you work hard to provide medically reasonable and necessary care to your patients to ensure their well-being. You deal with chronic and complex conditions, including hard-to-heal wounds. Treatment of these wounds often requires use of amniotic grafts and/or other skin substitute products. Your patients are pleased with the results and the care that you and your team provide to them.
Your favorable reputation grows and ultimately leads to a growing practice and increased revenue. Yet, you also spend considerable time navigating the increasingly complicated landscape of health care regulations, related audits and inspections, and demands to repay monies that the Federal health care programs and commercial plans claim you allegedly received in error. You suddenly remember what you always knew — health care is a team sport – from the patient-facing front lines to the back office and executive leadership – it takes a village. But, do you have the right team in place?
Adding to Your Existing Team
Why should you add to your team? Medicare and Medicaid, in particular, are reimbursing providers billions of dollars each year for using skin substitute products on patients. Given this staggering amount, dermatologists operating in the wound care space that use skin substitutes to treat diabetic foot ulcers, among other conditions, are at increased risk. You may be subject to audits and investigations related to your use of these products. The risks of these government actions are profound and have resulted in claw backs of millions of dollars dermatologists were previously paid. These claw backs have also included monies that dermatologists already paid to skin substitute manufacturers and distributors for the products.
The Players You Need
- Attorneys: Some law firms have a health care practice group, among many others, within its firm. Garfunkel Wild, P.C. is unique. We have one focus – health care. We represent the full spectrum of providers, businesses, and institutions that make health care delivery possible. As a result, we handle issues with a health care component anywhere in the country and we pride ourselves on offering practical, cost-effective solutions to our clients for more than 40 years. We specialize in representing providers, including dermatologists, who are audited or investigated for their use of skin substitute products.
- Medical Experts: Not all medical experts are created equal, especially when it comes to evaluating the medical necessity and efficacy of your use of skin substitute products. Garfunkel Wild retains the leading authorities, including nationally-recognized plastic surgeons and biomedical engineers, to (1) provide crucial insights on standard of care issues, (2) explain how and why certain products were developed and intended to be used, and (3) refute the findings and conclusions of the government’s “experts.”
- Billing, Coding, and Documentation Specialists: There is a saying in health care compliance that “if it isn’t documented, it didn’t happen.” Appropriately documenting your patient’s medical condition, any underlying comorbidities, and management of such prior to applying skin substitutes is critical. Garfunkel Wild partners with billing, coding, and documentation specialists, including those who formerly worked at the nation’s leading provider of advanced wound care therapies, to provide the strongest defense of your work possible.
It is no longer enough to simply hope for the best when participating in Medicare and Medicaid, especially if you are using skin substitutes on your patients. Proactively understanding and accounting for the risks is an important first step to protecting your practice, your reputation, and your livelihood. The next step is making sure that you have a dedicated team of attorneys, medical experts, and billing, coding, and documentation specialists in place before you need them. Government scrutiny of skin substitutes is not going away. Have a plan. Build the right team. Be prepared.
Should you have any questions regarding the above, please contact the authors, the Garfunkel Wild attorney with whom you regularly work, or contact us at [email protected].
