Why Do Your HBOT Payments Get Denied?

Commercial payers and Medicare seem to do everything they can to reduce or deny payments for Hyperbaric Oxygen Therapy (HBOT). It is beyond ridiculous. In 2017, Palmetto, one of Medicare’s payment processors, denied an average of 89% of their HBOT payments. You’re getting paid pennies on the dollar!

IntellicureEHR includes automatic documentation solutions that eliminate many payers’ reasons for HBOT payment denials. 

We asked Dr. Caroline Fife, renowned wound physician and author of the Wound Care regulatory blog CarolineFifeMD.com, to share her findings on the reasons HBOT payments get denied.

Here are 8 things you can do to reduce your HBOT payment denials from commercial and government payers:

8. The physician must order HBOT on each day that they plan to administer it. It’s a major pain to do, but it’s becoming a reason to deny payment.

7. The physician must order blood sugar tests if HBOT is performed.

6. Make sure that the HBO note has the correct indications for treatment in the note.

5. The physician must order the hyperbaric oxygen therapy and specify: Depth, Duration, Air breaks, Blood sugars, Expected number of treatments and SEGMENTS and FREQUENCY (i.e. Monday-Friday or BID, etc.)

4. The physician must define specific goals of treatment for each HBOT indication.

3. The physician must define how you are going to overcome obstacles to healing.

2. Documentation must support there is an improvement with HBO services and that it is reasonable to continue treatment.

1. The physician must reassess the wound every 30 days, including wound measurements.

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