Is your billing team ready for the CMS CY 2027 Physician Fee Schedule? See the proposed Medicare payment changes, RCM risks, and steps to prepare.

If you bill Medicare for wound care, you've probably heard the word WISeR by now. It's a new prior authorization program, and it started on January 1, 2026. For wound care practices, it's a big deal. Skin substitutes are the single largest thing it targets. What is WISeR? WISeR stands for Wasteful and Inappropriate Service Reduction Model. It's not a private insurance program. It's Medicare's own prior authorization system, run through the CMS Innovation Center. Here's how it

If you're billing Medicaid for a VFC-supplied vaccine and getting denied, the fix is almost always one of two things: you billed for the vaccine product itself, or you left off modifier SL. VFC vaccines come to your practice at no cost, which means Medicaid will only pay you for giving the shot, not for the product. Get that distinction wrong and the claim bounces every time. What the VFC program actually restricts The Vaccines for Children program supplies vaccines free of c

Wound care claim denials usually trace back to documentation gaps, not coding errors. Here's what payers actually need to approve clean claims.

Do you bill for skin substitutes in a wound care practice? If so, 2026 already feels different. CMS changed the payment rules for these products on January 1. Skin substitute billing in 2026 is no longer just about picking the right code. It's about a real cut in what you get paid. You may have already seen it show up on your remittance advice. Here's the short version. CMS used to pay for each product at its own rate. Now it pays one flat rate for almost all of them. Most of

Not sure when to bill CPT code 90471? Learn what it covers, how vaccine billing works, and the documentation needed to avoid claim denials.

Medicare Wound Care Billing Is About Building a Better Process If there's one takeaway from this guide, it's this: Successful Medicare wound care billing starts long before a claim is submitted. Many providers assume denials happen because of coding mistakes. While coding errors certainly occur, they're only one piece of the puzzle. Most payment delays happen because the documentation, diagnosis, CPT code, and Medicare policy don't fully support one another. Think about your

By now, one thing should be clear: most Medicare wound care denials don't happen because providers deliver poor care. They happen because the documentation, coding, and billing workflow don't fully support the service being billed. The good news is that many of these denials are preventable. The practices with the strongest reimbursement rates don't spend all their time appealing claims. Instead, they build a process that catches mistakes before the claim reaches Medicare. Le

One of the biggest misconceptions in wound care billing is that Medicare denies claims because providers choose the wrong CPT code. That certainly happens, but it isn't the most common reason. In our experience, most denials happen because the documentation, diagnosis, CPT code, and Medicare policy don't tell the same story. The provider performed the right service, but the medical record doesn't clearly explain why it was necessary. Let's look at the situations that cause th