Cellular & Tissue-Based Products Compliance Specialist – (CTPC-S)

Description

Cellular & Tissue-Based Products Compliance Specialist – (CTPC-S)

This training program provides healthcare professionals with structured guidance pertaining to clinical practice guidelines in Allograft / CTP use in wound care with a focused emphasis on clinical application, documentation accuracy, and Medicare compliance related to the use of CTP/Allografts in wound care. The course covers indications, limitations, documentation standards, billing and coding requirements, and strategies to prevent claim denials based on actual Medicare audits. With a focus on structured protocols and best practices, this program ensures providers have the tools necessary to optimize patient outcomes, justify medical necessity, and navigate CMS compliance requirements effectively.

Key Focus Areas

• Get insider insights from recent Medicare audit findings. Learn how to anticipate compliance challenges, stay ahead of CMS, and avoid frequently cited pitfalls that lead to claim denials.
• Learn a step-by-step approach with our 5-Week Wound Preparation Protocol to Ensure Eligibility for Graft Application.
• Gain access to a detailed checklist to ensure proper documentation and eligibility before graft application.
• Navigate the complexities of reimbursement with confidence, ensuring your claims meet Medicare’s stringent requirements.
• This training is grounded in real Medicare audit findings and practical applications to help you improve clinical outcomes and claim rejections.

Course Objectives

• Identify Clinical Indications for Allograft / CTP application in wound care.
• Recognize Limitations to Use, including contraindications and inappropriate application scenarios.
• Implement Documentation Standards to justify medical necessity and enhance compliance with Medicare guidelines.
• Follow the 5-Week Wound Preparation Protocol to ensure proper eligibility for graft application.
• Understand Billing & Coding Requirements to avoid common errors and ensure proper reimbursement.
• Utilize a Complete Pre-Graft Checklist to verify wound eligibility and proper documentation.
• Analyze Medicare Program Integrity Audit Outcomes and apply best practices to avoid common pitfalls in wound care reimbursement.

Course Curriculum Outline

(A)Covered Indications for Use

• Clinical scenarios warranting Allograft / CTP application.
• Reasonable & Necessary (R&N) criteria for approval.

(B) Limitations to Use

• Contraindications and restrictions for Allograft / CTP.
• Common scenarios of inappropriate use.
• Understanding maximum application limits, patient factors, and wound environment considerations.

(C)Documentation Standards for Medical Necessity

• Essential documentation criteria for compliance.
• Standard of Care (SOC) documentation requirements.
• Justification statements for Allograft / CTP applications.
• Importance of photographic evidence and measurement tracking.

(D) 5-Week Wound Preparation Protocol

• Week-by-week structured approach to wound preparation.
• Clinical interventions, diagnostics, and assessments needed before graft application.
• Ensuring wound optimization for successful graft integration.

(E) Billing & Coding Requirements

• CPT codes (15271-15278) and HCPCS coding principles.
• Documentation requirements for claim approval.
• Use of modifiers (JZ, JW, KX) and their implications.
• E/M service billing considerations.

(F) The Complete Pre-Graft Checklist

• Clinical and documentation readiness before applying Allograft / CTP.
• Ensuring appropriate wound management strategies.
• Verification of compliance with Medicare guidelines.

(G)Medicare Program Integrity Audit Analysis

• Insights from Medicare audit reviews.
• Common claim denial reasons and how to prevent them.
• Real-world case studies and corrective action planning.

Course Format

The program will be delivered via an in person lecture, followed by a Q&A Session. It will also be available virtually via live stream interactive sessions.

Schedule

Faculty

• Shawn Amersi, APRN AGPCNP-BC MSN WCS-C EDS-C

Advanced Practice Nurse | Board Certified Adult-Gerontology Primary Care Nurse Practitioner Adult Health | Wound Care Specialist |