HME Wound Care is available throughout Wisconsin. Wound Care Equipment & Supplies 2021 Riverside Drive Green Bay, WI 54301 (920) 465-3000 (800) 236-2619 Fax: (920) 465-3003 Hours of Operation: Monday-Friday 8:00am to 5:00pm (Emergency services available after hours) www.hmehomemedical.com 2013 HME Home Medical. 09/13
Wound Care HME Wound Care Coordinators supply a complete line of products for the treatment of complex wounds, including Negative Pressure Wound Pumps, Surgical Dressing Supplies, and Offloading Equipment. We are the critical link between a Provider s plan of care and the supplies needed for patient compliance. We are experts on reimbursement and reimbursement alternatives. HME Wound Care is committed to providing education to patients, families and caregivers with a focus on the best possible outcome. Reimbursement options include Medicare, Medicaid and most insurance plans.
Negative Pressure Therapy and Offloading Equipment Negative Pressure Wound Pump Negative Pressure Wound Therapy is indicated to help promote wound healing through means including: drainage and removal of infectious material or other fluids, under the influence of continuous and/or intermittent negative pressures. Wounds that may qualify include: Chronic Acute Traumatic Subacute and dehisced wounds Partial thickness burns Ulcers (such as diabetic or pressure) Flaps and grafts Offloading Equipment HME offers solutions allowing patients to achieve compliance while enjoying the brighter things in life. The knee walker is a crutch substitute that can safely provide patients stability and mobility in their home or community. 3 4
wound care products Dressings Calcium Alginate Specialty Foams Collagen Hydrogel Sheets Gauze and Tape Hydrocolloids Debriders Therapeutic Support Surfaces Low Air Loss Beds Alternating Pressure Pads Mattress Overlays Wound Care Products Compression Pumps Foam & Gel Pads Custom Wheelchairs & Seating Specialized Footwear Seat Cushions PRODUCT ORDERS & REORDERS Call (920) 465-3000 to have products delivered to the patient s door with no additional shipping charge. Most supplies arrive in 2-3 days. Qualifying Criteria per Medicare Guidelines Surgical Dressing Supply Medicare allows qualifying wounds a primary and secondary wound care product. If the treatment plan requires dressings outside the primary and secondary layers, documentation of medical necessity is required. To qualify: Patient must have wound caused by, or treated by, a surgical procedure. OR Wound must have been debrided by one of the following methods: Surgical (sharp instrument) Mechanical (wet to dry, irrigation with salijet) Chemical (enzymatic) Autolytic (occlusive dressing, use of alginate) 5 6
Qualifying Criteria per Medicare Guidelines Dressing Frequency Drainage Thickness/Stage Special Comments Gauze Up to 3x/Day Any Any Roll Gauze Up to 3x/Day Any Any Impregnated Gauze Daily Any Any Contact Layer 1x/week Any Any Hydrocolloid 3x/week Minimal-Moderate Any Gel Fillers wound must have cavity Transparent 3x/week Minimal Partial Thickness/Stage 2** ABD Pads Daily Moderate-Heavy Full Thickness/Stage 3 or 4** Calcium Alginate Daily Moderate-Heavy Full Thickness/Stage 3 or 4** Includes Silver Alginates Foam/ Boardered Foam 3x/week Moderate-Heavy Full Thickness/Stage 3 or 4** Includes Silver Foams Hydrogel Fillers 3 oz/month None-Minimal Full Thickness/Stage 3 or 4** Wound must have cavity Hydrogel Gauze/Sheet Daily None-Minimal Full Thickness/Stage 3 or 4** Collagen Daily Any Full Thickness/Stage 3 or 4** Dressing size must be based on and appropriate to the size of the wound. **Refer to page 12 for definitions of Stage 2, 3 and 4 pressure ulcers. 7 8
Qualifying Criteria per Medicare Guidelines Specialty Bed: Group-1 A Group-1 mattress overlay or mattress is covered if one of the following three criteria are met: 1) The patient is completely immobile i.e., patient cannot make changes in body position without assistance, or 2) The patient has limited mobility i.e., patient cannot independently make changes in body position significant enough to alleviate pressure and at least one of conditions A D below, or Specialty Bed: Group-2 A Group-2 support surface is covered if the patient meets: 1a) The patient has multiple stage II pressure ulcers located on the trunk or pelvis (ICD-9 707.02 707.05), and 1b) Patient has been on a comprehensive ulcer treatment program for at least the past month which has included the use of an appropriate Group-1 support surface, and 1c) The ulcers have worsened or remained the same over the past month, or 3) The patient has any stage pressure ulcer on the trunk or pelvis and at least one of conditions A D below. Conditions for criteria 2 and 3: (in each case the medical record must document the severity of the condition sufficiently to demonstrate the reasonable and necessary need for a pressure reducing support surface): A. Impaired nutritional status B. Fecal or urinary incontinence C. Altered sensory perception D. Compromised circulatory status 2) The patient has large or multiple stage III or IV pressure ulcer(s) on the trunk or pelvis (ICD-9 707.02 707.05), 3a) The patient had a recent myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis (surgery within the past 60 days) (ICD-9 707.02 707.05), or and 3b) The patient has been on a Group-2 or -3 support surface immediately prior to a recent discharge from a hospital or nursing facility (discharge within the past 30 days). 9 10
Qualifying Criteria per Medicare Guidelines Medicare Staging of Pressure Ulcers Suspected Deep Tissue Injury: Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue. Stage I: Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. Stage II: Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister. Stage III: Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Stage IV: Full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling. Unstageable: Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. 11 12
Regional Wound Care Specialists Sarah Hannemann 13 Specialty Care Coordinator 10 years experience post-mastectomy fitter lymphedema fitter PTA graduate Erin Kramer, RN, BSN Wound Care Coordinator 10 years experience wound care surgery rheumatology Jenna Samz Specialty Care Technician 6 years experience wound care post mastectomy fitter lymphedema fitter PTA graduate Angela Smet Regional Wound Care Coordinator 12 years experience complex wound care Negative Pressure Wound Therapy hyperbaric medicine Brenda Steinfeldt, LPN Customer Service Manager 20+ years experience wound care ostomy care lymphedema fitter HME HOME MEDICAL INSURANCE CONTRACT LIST Partial list of contracted carriers, as of 09/26/13. HME facilitates payments with hundreds of payors.this insurance list is subject to change. HME IS a provider for: Aetna only with HealthEOS networks Anthem Blue Cross Blue Shield Arise Auxiant Care Improvement Plus Coalition America Network Cypress Group Health Cooperative Eau Claire Health EOS Multiplan Network HIRSP (WI State Risk Sharing Plan) Homelink HPS Health Payment Systems Medicaid Care Wisconsin First Children s Community Health Plan Community Connect Forward Health Lakeland Care MHS Managed Health Plan UHC Community Plan MSC Care Mgmt Network Health PHCS Savility Network PMCS Professional Medical Claim Solutions Network Prairie States Prevea Health Network Prevea 360 (exclusive) TRPN Three Rivers Provider Network Tricare and ChampVA Trilogy Network Medicare Advantage Plans AARP Medicare Complete Advantage by MHS Aetna Medicare Open Plan Anthem BCBS Medicare Advantage Health Net Medicare icare Independent Care Health Plan Network Platinum Plus & Special Needs Pyramid/Today s Options UHC Dual Complete United HealthCare Medicare HME is NOT a provider for: CIGNA (we may provide if a Multiplan Network PPO) GEHA HUMANA and any ChoiceCare related plans Michigan Medicaid Molina Health Care (formerly ABRI) UMR Aurora Groups WPS Statewide Network 14