Hi Caroline,
I just read the great article by Mike Crouch on the UPIC audits around skin substitutes. We’re looking at a UPIC denial for a patient we successfully grafted last year. They claim we had no weekly measurements! Absurd!!
They said we don’t measure wounds (are you kidding me?!) They claimed we didn’t try any other conventional wound care (we did provide conventional wound care for months and provided the documentation to prove it which the UPIC clearly didn’t read). The list goes on and on. They did not read anything in our charts, no question!
I’ve come to the realization that UPIC does not read anything and uses the same excuses for denial for everyone. Clinicians should understand that they WILL be audited and they WILL get a denial no matter how great their documentation is.
I intend to volunteer for the WISeR prior authorization model because given our excellent documentation, we will be better off in the PI model and getting our “gold card” than spending 15 months (plus legal fees) to get paid for providing excellent patient care. I will keep you posted!
[Name withheld for now…]
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
