PODCAST

Reimbursement Readiness

Wound Care Today USA

Business Tip for all types of wound practices. Hosted by Kathleen D. Schaum and Friends.

health & fitness medicine

All Episodes

00:07:09

Ep.15 WISeR Model 2026

Reimbursement Readiness ·

2025/12/18

In Episode 15, Kathleen Schaum and Amiee Coriano walk Wound Care Today USA subscribers through CMS’s new WISeR Model, a national initiative designed to reduce fraud, waste, and abuse by applying prior authorization and enhanced medical review to select services in traditional Medicare. While the 2026 payment rules for CTPs are now known, this episode underscores a critical point for every revenue cycle: coverage and payment require meeting Medicare’s policy expectations—not simply billing a payable

00:15:09

Ep.14 2026 Home Health Payment Updates

Reimbursement Readiness ·

2025/12/11

Kathleen welcomes Yesenia Banks to break down Medicare’s 2026 Final Rule for Home Health Agencies and DME suppliers, rounding out the series on year-ahead payment policy. Yesenia explains the Patient-Driven Groupings Model (PDGM)—how 30-day periods, admission source/timing, clinical groupings (including wounds), functional status, and comorbidity adjustments combine into case-mix weights and payment. She also clarifies LUPA thresholds, outlier scenarios, and why accurate, specific diagnosis coding

00:18:40

Ep.13 Payment: OPPS Final Ruling (2026)

Reimbursement Readiness ·

2025/11/26

Kathleen walks hospital-owned outpatient wound and ulcer management teams through the OPPS Final Rule for 2026, clarifying how CMS turns policy into payment via APC groupings and where to locate the official national rates in Addendum A (by APC) and Addendum B (by HCPCS). She details the headline changes for CTPs: unpackaging products from the application procedures, eliminating high/low cost tiers, establishing a single OPPS product rate of $127.14 per cm² (not geographically adjusted), and

00:17:46

Ep.12 Payment: MPFS Final Ruling (2026)

Reimbursement Readiness ·

2025/11/13

In Episode 12 of Reimbursement Readiness: Business Tips for Wound Practice, Kathleen Schaum unpacks the 2026 Medicare Physician Fee Schedule (MPFS) Final Rule—a document that determines how physicians and qualified healthcare professionals (QHPs) will be paid in the coming year. She explains how this 2,000-page rule shapes the final payment policies for services, procedures, and products, and highlights key changes across telehealth, surgical services, chronic care, and, most importantly, cellular

00:04:36

NEWSFLASH: Major CMS Changes for CTPs in 2026!

Reimbursement Readiness ·

2025/11/01

Reimbursement expert Kathleen D. Schaum, M.S. and Jeremy Bowden, President of WCT USA, break down the CY 2026 Medicare PFS Final Rule's bombshell changes to skin substitutes and CTPs!The Big Change: CMS is completely overhauling how skin substitutes are paid—moving from ASP-based methodology to incident-to supplies with product-category payment grouping.The Numbers That Matter: Part B spending exploded from $252M (2019) → $10B+ (2024) New payment rate: ~$127.28 (single rate for CY

00:11:26

Ep.11 Contracting

Reimbursement Readiness ·

2025/10/30

In Episode 11 of Reimbursement Readiness: Business Tips for Wound Practice, Kathleen Schaum welcomes back Amiee Coriano, CEO of AMC Medical Consulting, for an in-depth discussion on contracting with commercial and private payers.Amiee explains the critical differences between credentialing and contracting, then walks through the essential elements every provider should understand before signing a payer agreement — from timely filing limits and fee schedules to plan types, coverage definitions, and

00:03:30

Special Announcement - CMS Claims Hold REVERSED!

Reimbursement Readiness ·

2025/10/17

Great News About the CMS Claims Hold!On October 15, 2025 Kathleen Schaum shared some bad news that was going to affect the cash flow of all professionals paid by the Medicare Physician Fee Schedule. Now on October 17, 2025 listen to Kathleen explain the breaking great news about the CMS Claims Hold.

00:17:27

Ep.10 Credentialing

Reimbursement Readiness ·

2025/10/16

In Episode 10 of Reimbursement Readiness, Kathleen Schaum welcomes listeners back and reintroduces her guest, Amiee Coriano, CEO of AMC Medical Consultant. Kathleen highlights Amiee’s expertise in wound and ulcer management, coding, and billing, and sets the stage for another practical discussion on navigating reimbursement challenges in wound care. This episode continues the conversation with Amiee Coriano, who brings her deep experience in coding and compliance to address real-world reimbursement

00:05:00

Special Announcement - CMS Claims Hold May Affect...

Reimbursement Readiness ·

2025/10/16

If you are paid according to the Medicare Physician Fee Schedule, CMS has indefinitely extended the hold on your payment. Listen to host of Reimbursement Readiness Kathleen D. Schaum, M.S.explain this breaking news.

00:14:26

Ep.09 The Right Professional, The Right Work, In the...

Reimbursement Readiness ·

2025/10/02

In Episode 9 of Reimbursement Readiness, Kathleen Schaum welcomes listeners back and reviews the progress made so far in understanding coverage policies, ICD-10-CM diagnosis codes, and ulcer classification. To continue the journey, she introduces a new guest expert who joins to share her insights on reimbursement and coding in wound care practice. This episode features special guest Amiee Coriano, who guides providers through the latest updates and practical strategies in wound care reimbursement

00:10:27

Ep.08 New ICD-10-CM Diagnosis Codes for Wound/Ulcer...

Reimbursement Readiness ·

2025/09/18

In this episode, Donna Cartwright walks providers through the newly released ICD-10-CM diagnosis codes for wound and ulcer management, effective October 1st. She explains what has changed, why these updates matter for clinical practice, and how to apply them correctly in documentation and reimbursement. Listeners will gain clarity on the latest code additions, adjustments, and practical strategies to stay compliant and ensure accurate claims submission.

00:15:40

Ep.07 Wound vs. Ulcer: Select the Correct Diagnosis Code

Reimbursement Readiness ·

2025/09/04

In Episode 7 of Reimbursement Readiness: Business Tips for Wound Practice, Donna Cartwright joins Kathleen Schaum to tackle one of the most frequently asked questions in wound care coding: When should you report a wound or when should you report an ulcer?Donna breaks down the distinctions between acute wounds and chronic ulcers, covering examples from lacerations, burns, and surgical complications to diabetic and venous ulcers. She explains where to find these codes in the ICD-10-CM, when seventh

00:07:57

Ep.06 Matching Diagnosis Codes to Procedures

Reimbursement Readiness ·

2025/08/21

In this episode, Donna Cartwright explains why it’s critical to match ICD-10-CM diagnosis codes with the appropriate procedure codes outlined in Medicare’s Local Coverage Determinations (LCDs) and Local Coding and Billing Articles (LCAs). She breaks down six key reasons these code lists matter—from ensuring medical necessity and preventing improper payments to minimizing denials, reducing audit risk, and maintaining Medicare program integrity. Listeners will also learn about the risks of incorrect

00:12:24

Ep.05 Specific Diagnosis Coding Instructions for...

Reimbursement Readiness ·

2025/08/07

Episode 05 – Specific Diagnosis Coding Instructions for Venous UlcersIn Episode 5 of Reimbursement Readiness: Business Tips for Wound Practice, expert Donna Cartwright returns to guide wound care professionals through ICD-10-CM coding for venous ulcers. This in-depth episode covers:Key coding terms in the Alphabetic Index: atherosclerosis, varicose veins, post-thrombotic syndrome, and chronic venous hypertensionNavigating ICD-10-CM code ranges (I70, I83, I87, L97) and using combination codesApplying

00:18:30

Ep.04 Specific Diagnosis Coding Instructions

Reimbursement Readiness ·

2025/07/24

Episode 04 – Specific Diagnosis Coding InstructionsIn Episode 4 of Reimbursement Readiness, Donna Cartwright dives deep into ICD-10-CM diagnosis coding for diabetic ulcers. She walks listeners through using the Alphabetic and Tabular Indexes, explains how to apply combination coding with ulcer severity, and highlights important coding notes such as “code first” and “use additional code.” You'll also learn the distinctions between Excludes 1 and Excludes 2 notes, and how causal relationships are

00:10:48

NEWS FLASH: Major Medicare Proposed Rule Changes...

Reimbursement Readiness ·

2025/07/23

NEWS FLASH: Major Medicare Proposed Rule Changes Affecting CTPs7/23/2025 – CMS recently released proposed 2026 changes to the Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (HOPPS)—including a major shift in reimbursement for cellular and/or tissue-based products (CTPs).In this Reimbursement Readiness News Flash, expert Kathleen Schaum breaks down what providers need to know now and how to prepare for potential reimbursement changes for CTPs used in wound care.Let

00:14:54

Ep.03 Report Diagnosis Correctly at Every Encounter

Reimbursement Readiness ·

2025/07/10

Episode 03 – Report Diagnosis Correctly at Every EncounterIn Episode 3, coding expert Donna Cartwright joins Kathleen Schaum to begin an essential series on ICD-10-CM diagnosis coding. Listeners will gain a foundational understanding of how the ICD-10-CM system was developed, why it was adopted in the U.S., and how the codes are structured across the Alphabetical and Tabular Indexes. Donna explains how diagnosis codes provide specificity, support medical necessity, and impact reimbursement outcomes

00:09:13

Ep.02 Q&A: Medicare Coverage Guidelines for Every...

Reimbursement Readiness ·

2025/06/26

In this episode, Kathleen Schaum answers the most frequently asked subscriber questions about Medicare’s coverage guidelines for wound/ulcer management. She clarifies how standard LCDs, LCAs, and documentation articles—especially those related to surgical dressings—should serve as your practice’s “reimbursement playbook.” Listeners will gain practical strategies for aligning clinical documentation with payer expectations and preparing confidently for audits. Tune in to ensure your documentation

00:11:15

Ep.01 About LCDs and LCAs

Reimbursement Readiness ·

2025/06/12

In this foundational episode of Reimbursement Readiness, Kathleen Schaum walks listeners through the structure and importance of Medicare’s Local Coverage Determinations (LCDs) and Local Coding and Billing Articles (LCAs). Learn how to identify and use these key documents to support your wound/ulcer management practice, avoid costly audit errors, and build a solid reimbursement strategy. Get ready to challenge common myths, refine your documentation, and prepare for future episodes with expert

00:04:02

Ep.00 The Introduction Part 2

Reimbursement Readiness ·

2025/05/29

Reimbursement Readiness: Introductory Episode – Part 2In Part 2 of the introductory episode, Kathleen Schaum introduces the foundation for all upcoming reimbursement discussions: Medicare’s Local Coverage Determinations (LCDs) and Local Coding and Billing Articles (LCAs). These essential documents serve as your roadmap to Medicare coverage. Learn how to identify the LCDs and LCAs relevant to your wound/ulcer management services and why reviewing them is a critical first step toward successful

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