Why Wound Care Providers Are Facing More Reimbursement Denials & What You Can Do About It

Over the past several years, Medicare has intensified its scrutiny of advanced wound care products; especially skin substitutes, amniotic membranes, and other regenerative therapies. Unfortunately, this crackdown didn’t arise in a vacuum. Not a small number of bad actors in the wound care industry have engaged in overbilling, misuse, questionable billing practices, and outright fraud. As a result, The Center for Medicare & Medicaid Services has instituted stricter requirements, tighter documentation standards, and more aggressive reviews.

While these measures were intended to prevent abuse, they have also created an unintended consequence: legitimate wound care providers and podiatrists are increasingly being denied reimbursement for medically necessary, evidence-based therapies. And the aftereffects are tragic.

How This Is Impacting Patient Care—A Case Report from Louisiana

RegenEdge Ventures (parent company of Wound Care Portal) has been actively speaking with a medical sales representative in Louisiana who works closely with clinics and podiatrists throughout the state. According to her, many wound care providers are no longer using skin substitutes for their patients because they have been denied Medicare reimbursement too many times in recent cases, regardless of the clinical justification or the product’s track record. As a direct result, many patients are not receiving the most advanced modalities available; products that have been shown to close wounds faster and prevent catastrophic complications.

As a result, she told us, there has been a noticeable increase in amputations in her territory.

When advanced products are removed from the provider’s toolbox, chronic wounds linger longer, infections progress, and lower-extremity complications spiral. For a diabetic patient with peripheral vascular disease or neuropathy, the difference between early application of a skin substitute and delayed care can literally be the difference between limb salvage and amputation.

Are You Experiencing the Same Challenge?

If you’re a wound care provider or podiatrist who has been denied reimbursement for skin substitutes, amniotic membranes, or any form of advanced wound care, you’re not alone. And more importantly, there are tools that can help.

RegenEdge Ventures is working to support clinicians navigating this new reimbursement landscape.

Request Your Free Wound Care Checklist & Explainer

If you have been denied reimbursement for advanced wound care, we have created a resource you may find helpful:

📩 Email us and request your free Wound Care Checklist and Medicare Explainer

admin@regenedgesummit.com

Or contact us here to set up a time for a call.

Wound care providers should not have to choose between what’s best for their patients and what insurance will approve. Together, we can work toward ensuring proven therapies remain accessible to the patients who need them most.

If you want the checklist or want to share your reimbursement challenges, reach out. We’re here to support you.

* This blog is for informational purposes only and is not a substitute for professional medical or billing advice.