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 and/or tissue-based products (CTPs) for skin wounds. Kathleen also clarifies the distinction between the MPFS and the final rule itself, showing how conversion factors and relative value units translate to real-world reimbursement rates.

Listeners will gain a clear understanding of how 2026 payment updates affect both the application and product sides of CTP reimbursement. Kathleen explains why non-facility rates are increasing while facility rates are decreasing, and how CMS is introducing a single national allowable rate of $127.28 per square centimeter for most CTPs—with exceptions for BLA-approved and non-sheet products. She also emphasizes the importance of reviewing payer-specific coverage policies, reminding providers that a listed code or rate does not guarantee payment. The episode concludes with guidance on where to access the official Medicare links and an invitation to join Kathleen and Dr. Alton Johnson for a Wound Care Today USA Learning Live event covering CTP strategies for 2026.

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 2026)
• Effective: January 1, 2026

Kathleen and Jeremy provide the reimbursement roadmap and what this means for your Q1 2026 planning.

Read the CMS PFS Final Rule: https://lnkd.in/e6aHqJ73

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 provider obligations. She shares insights on when and how to renegotiate contracts, how to add new services or products, and common mistakes that can lead to claim denials or lost revenue.

Whether you’re starting a wound care practice or refining your existing operations, this episode offers clear, actionable guidance for managing payer relationships and ensuring compliant reimbursement. Plus, subscribers can download Amiee’s companion contracting handout, which defines key contract terms and payer plan types referenced throughout the discussion.

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. 

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 issues. She shares insights into common billing errors, strategies for optimizing documentation, and key considerations that providers should keep in mind to ensure accurate claims submission. Listeners will gain practical guidance to strengthen their wound care practice’s financial readiness while staying aligned with payer expectations.

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.

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. She explains how to approach new coding scenarios, highlights common pitfalls to avoid, and shares actionable tips for staying compliant while improving documentation. Listeners will walk away with a stronger grasp of real-world applications that support both patient care and accurate payment.

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.

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 characters are required, and why understanding the difference is essential for proper reimbursement. You’ll also hear best practices for coding multiple wounds, linking diagnoses to treatments, and navigating payer requirements for underlying causes versus manifestations.

By the end of this episode, clinicians and coders alike will gain clarity on how to code accurately and confidently, ensuring compliance while telling the patient’s story correctly in the medical record.

DOWNLOADS

Acute Wound Handout

Chronic Ulcer Handout

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 or unspecified coding, including overpayment recovery, sanctions, and reputational harm. This episode equips wound care professionals with practical strategies to code accurately, stay compliant, and protect their reimbursement.