My Scope of Practice: Reimbursement Lifeline

“Learning is not attained by chance, it must be sought for with ardor and attended to with diligence.” — Abigail Adams

  Coding, coverage, and payment — realities that can stop even the best health care professionals in their tracks. Are you coding to the highest level? Are you following the latest payment regulations? Why should you even care about coverage?

  While many wound care professionals have only a basic knowledge of these issues, Kathleen D. Schaum, MS (photo) wrote the book (literally) on them. Kathleen always has been involved in the business side of medicine. After more than 10 years working as a Nutrition Services Payment Coordinator, Assistant Professor of Nutrition, and Director of Food and Nutritional Services (Kathleen is a registered dietitian), she shifted careers to sales of medical equipment and advanced wound care supplies and was able to share her knowledge of the various payment systems with her customers. During the next 15 years as a sales representative and then as a sales manager, Kathleen discovered many health care professionals were not as fortunate as she in terms of learning about the coding, coverage, and payment that pertains to their business.

  Although Kathleen has reimbursement knowledge regarding numerous medical specialties, she has nurtured a passion for wound care. “While I was in medical sales, I became enamored with the outpatient wound care departments, wound care physicians, skilled nursing facilities, and home health agencies that manage very difficult chronic wounds,” Kathleen says. “I am also partial to the wound care manufacturers who produce unique and cutting-edge technology to assist wound care professionals in their challenging work. In fact, I often tell these wound care stakeholders they are the best kept secret in the medical industry. Every time I show one of them how to code, obtain coverage, and receive appropriate payment for their work, I know a patient with a chronic wound is receiving the benefit of the procedure, product, or service.”

  Near the end of her sales career, many of Kathleen’s customers were wound care professionals who relied on her to educate them about the correct coding, coverage, and payment for the wound care procedures, products, and services they provided in various sites of care. Those customers convinced her to open a reimbursement strategy consulting company in 1997. Through that company (Kathleen D. Schaum & Associates, Inc, Lake Worth, FL), she has educated wound care manufacturers, facility staff, and wound care professionals. She has conducted nearly 100 executive wound care reimbursement workshops for senior executives of wound care manufacturers; consulted to numerous outpatient wound care departments/professionals who needed to improve their understanding of wound care coding, payment, and coverage regulations; applied for and received HCPCS codes and CPT codes for more than 250 wound care products/services; and founded and taught the all-day wound care reimbursement seminar entitled Wound Clinic Business, which started out in 4 cities per year and is now presented in 10 cities per year. Kathleen also has presented numerous reimbursement sessions at most national US wound care symposiums as well as at many US regional and local wound care symposiums. For more than a decade, Kathleen also has written monthly reimbursement columns for the journals Advances in Skin & Wound Care and Today’s Wound Clinic.

  In addition to her consulting work, Kathleen also worked as the Reimbursement Director for Johnson & Johnson Medical (Arlington, TX) from 1998 to 2000. She is currently with Smith & Nephew, Inc (Fort Worth, TX), formerly Healthpoint Biotherapeutics, where she directs all coverage, coding, and payment endeavors for tissue management products and procedures. Kathleen also evaluates all new business development, licensing, and acquisition opportunities from the reimbursement/payment perspective and trains internal staff, sales representatives, and providers on how to implement wound care programs and appropriately receive reimbursement/payment from major payers.

   “I used to teach wound care stakeholders why they should care about coding, payment, and coverage,” Kathleen says. “Now I am constantly answering questions from wound care stakeholders about how; how to code, how a particular payment system works, and how to locate coverage information. The most challenging aspect of my responsibilities is staying on top of new coding, payment, and coverage regulations that pertain to wound care.”

  Kathleen’s desire to continue educating wound care stakeholders about ever-changing reimbursement systems drives her — she diligently reads and analyzes thousands of pages of reimbursement information annually. “It is like an addiction,” Kathleen says. Keeping her knowledge current because she knows so many wound care stakeholders depend on her reimbursement information fuels her ardor for her scope of practice.

This article was not subject to the Ostomy Wound Management peer-review process.