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.
US Wound RegistryIf 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.

Dr. Fife sees patients at the CHI St. Luke's Hospital Wound Clinic in The Woodlands, Texas. For an appointment call (936) 266-2150.

%d bloggers like this: