Medipyxis adds real-time Medicare Part A/B check for wound care teams

Medipyxis has launched a day-of-service Medicare Part A/B coverage check inside its billing workflow to help mobile wound care teams avoid preventable claim denials. The tool is aimed at a common SNF billing problem where a patient’s benefit status can shift after referral intake but before treatment.

Why it matters: - Mobile wound care teams can lose reimbursement when a patient’s Medicare status changes between referral intake and the day of service. - A real-time check can flag Part A skilled nursing facility stays before a claim is submitted to Medicare Part B. - The feature targets a major source of denial risk for graft-related wound care claims in skilled nursing facilities.

What happened: - Medipyxis, Inc. announced a real-time Medicare Part A / Part B coverage check built into its clinical billing workflow. - The feature is available immediately to all Medipyxis customers at no additional cost. - The tool is designed for mobile wound care teams using the Medipyxis wound care practice management platform.

The details: - The check runs from the patient billing page with a single click at the time of service. - The system queries real-time Medicare eligibility data through the Stedi clearinghouse. - The workflow cross-references hospital and SNF admission records. - The system returns a determination for Part A stay, Part B, or Medicare Advantage. - The result includes a confidence level and source evidence. - If the patient’s status has changed since the previous check, the system surfaces an alert for the care team to confirm before proceeding. - Every check creates a timestamped, append-only audit record. - The feature is a clinical decision support tool and does not block a clinician from delivering care. - Medipyxis said the feature is meant to address a gap between initial insurance verification and day-of-service coverage status. - Damon Ebanks, president and CEO of Medipyxis, said a patient can move from verified Part B coverage to a Part A SNF stay without the coverage expiring.

Between the lines: - Medicare Part B spending on skin substitutes increased nearly 40-fold between 2019 and 2024, according to CMS data. - That spending growth has intensified payer scrutiny on wound care billing. - Under SNF consolidated billing rules in 42 CFR 411.15, services furnished during a covered Part A stay are bundled into the facility payment. - Claims submitted to Medicare Part B for those services are denied and are not appealable as revenue recoveries. - The new workflow shifts the check earlier in the clinical visit, when staff can still verify status before treatment decisions are made.

What's next: - Medipyxis will likely use the new coverage check as part of its broader billing and compliance workflow for wound care teams. - The feature may reduce avoidable denials for practices that routinely treat patients in skilled nursing facilities. - Medipyxis continues to market its platform to wound care practices across the United States.

The bottom line: - Medipyxis is trying to close a costly billing blind spot by checking Medicare coverage at the bedside instead of at referral intake. - For mobile wound care teams, that timing could be the difference between a paid claim and an automatic denial.