Yesterday I posted some of the reasons for denial of HBOT under prior authorization. I thought I’d point out something that should be obvious but might not be. It appears that HBOT is being denied for DFUs unless—at a bare minimum: Hemoglobin A1C is being checked and recorded, vascular screening is performed (more than checking pulses) and followed up if abnormal, and there is documentation of off-loading at every visit. This is a perfect description of the “appropriate use of HBOT in DFU” quality measure available through the US Wound Registry.
If I was a hospital wanting to implement a quality plan for my outpatient centers that would help ensure reimbursement, or if I was a payer looking at quality performance, or if I was a management company with any financial “skin in the game” with centers or providers, then I’d be getting my clinicians to report this measure as a way to evaluate how they might perform when prior authorization of HBOT comes to a MAC jurisdiction near you. Because, I can virtually guarantee that prior authorization of HBOT will eventually be required everywhere.