Ep.16 Unravelling Coding, Coverage, and Compliance with Kathleen Schaum

In this episode of WoundCasters, host Felix Boecker sits down with Kathleen Schaum, one of the most respected voices in wound care reimbursement, to unpack the realities of coding, coverage, and payment in an increasingly complex healthcare system. With more than five decades of experience in reimbursement education, consulting, and policy interpretation, Kathleen offers a rare longitudinal perspective on how wound care payment has evolved—from a time with few sites of service and minimal coverage options to today’s fragmented, highly regulated reimbursement landscape.Kathleen explains how the introduction of DRGs, outpatient departments, home health, and skilled nursing facilities reshaped wound care delivery—and why reimbursement was never designed as a master plan. The conversation dives into common pitfalls clinicians face today, including misunderstanding coverage versus prior authorization, failing to read payer contracts, and underestimating the importance of clear, concise documentation. Kathleen emphasizes that while many wound care professionals no longer struggle to get paid, they increasingly struggle to keep what they’re paid due to audits, denials, and documentation gaps.The episode also addresses education gaps for clinicians, manufacturers, and innovators alike. Kathleen shares why reimbursement must be considered early—whether setting up a new practice, launching a product, or developing new technology—and why documentation should tell a clear, defensible story that meets medical necessity standards. From advice for new clinicians entering wound care to guidance for manufacturers navigating FDA clearance and payment pathways, this conversation reinforces a central truth: clinical excellence alone isn’t enough. Understanding reimbursement is essential to sustaining wound care practices and ensuring patient access to care.