Wound-Care Documentation Review
Review wound measurements, photographs, debridement history, conservative care, treatment progression, vascular status, offloading, orders, product use, and medical necessity support.
Services
Arclight Audit & Appeals
Post-payment audit response and Medicare appeal support for wound-care providers facing overpayments, recoupments, contractor reviews, and ALJ-stage disputes.
A post-payment Medicare audit can place months or years of wound care, multiple patients, and substantial reimbursement at risk. The defense must make a large and often fragmented clinical record understandable claim by claim.
Arclight combines wound-care operating experience, documentation analysis, Medicare policy, denial-rationale review, evidence mapping, appeal writing, and hearing preparation to build a coherent record from the audit response through the ALJ stage.
The result is a disciplined, adjudicator-ready presentation: patient timelines, wound-level evidence, issue maps, policy responses, exhibit packets, and hearing strategy built around the facts that decide the case.
Audience
- Wound-care providers
- Mobile providers
- Physician groups
- Advanced practice providers
- Suppliers
- Healthcare organizations
Post-payment audit and appeal support
- UPIC, MAC, SMRC, RAC, and TPE post-payment reviews
- Overpayment determinations and recoupment
- Skin substitute and wound-care claim audits
- Documentation and medical necessity denials
- Redetermination and QIC reconsideration
- ALJ appeals, hearing preparation, and representation
Looking for product access and prepayment support?
Arclight Access offers Product Only, Prepayment Reimbursement Support Only, and a Complete Program that combines separately priced product and support components.
Estimated cost savings
For wound-care providers facing $500,000 to $2 million in audit exposure, a full legal-team approach can become a six-figure defense project. Arclight-led support keeps the core record, policy, appeal, and hearing work in place while reserving outside counsel for targeted legal issues when needed.
| Audit exposure | Full legal team | Arclight-led support | Estimated savings |
|---|---|---|---|
| $500,000 audit | $75,000-$175,000 | $30,000-$75,000 | $45,000-$100,000 |
| $1 million audit | $125,000-$250,000 | $50,000-$110,000 | $75,000-$140,000 |
| $2 million audit | $200,000-$400,000+ | $85,000-$175,000 | $115,000-$225,000+ |
Service areas
Skin Substitute Audit Strategy
Build patient-specific and product-specific support around wound type, failed conservative care, product identification, graft sizing, orders, photographs, and treatment response.
Denial Rationale Analysis
Map contractor rationales against the record, Medicare policy, claim facts, and available evidence, including rationale drift across appeal stages.
Patient and Claim Evidence
Build patient timelines, wound-level summaries, claim maps, outcomes evidence, issue matrices, and adjudicator-ready exhibits.
Appeal Packet Development
Prepare redetermination, reconsideration, and ALJ submissions with issue-by-issue responses, supporting evidence, and organized exhibits.
ALJ Preparation and Representation
Develop the hearing theory, exhibit index, testimony plan, patient-level defense packets, and concise presentation for the ALJ hearing.
Engagement options
Audit Triage Review: $5,000-$15,000
Review the audit scope, documentation risk, denial theory, missing-record needs, deadlines, and recommended defense strategy.
Appeal Record Buildout: $25,000-$75,000
Build patient summaries, issue-by-issue responses, exhibit organization, documentation analysis, policy support, and appeal materials.
Full ALJ Preparation and Representation: $75,000-$175,000
Develop the full case strategy, hearing brief, exhibit index, witness preparation, patient-level packets, policy exhibits, and hearing presentation.
Hybrid Counsel Support: custom
Work alongside healthcare counsel so specialized record, clinical, and policy development is handled efficiently while counsel addresses targeted legal issues.
Audit and appeal outputs
- Audit posture and vulnerability assessment
- Patient and wound timelines
- Missing-records list
- Claim-level issue map
- Patient-by-patient appeal packets
- Issue-by-issue contractor response
- Policy and evidence framework
- Outcomes and real-world evidence exhibits
- ALJ hearing strategy and testimony outline
- Documentation improvement recommendations
Audit and appeal process
01
Assess the audit posture
Review the contractor, procedural stage, deadlines, claim universe, and asserted denial rationale.
02
Organize the record
Build the patient, wound, claim, product, and documentation structure needed to analyze the case.
03
Map every issue
Compare each rationale against the record, Medicare policy, claim facts, and available evidence.
04
Build the appeal
Develop the narrative, patient summaries, issue responses, exhibit list, and supporting evidence.
05
Prepare and present
Prepare the provider and record for the next appeal stage and present the case at the ALJ hearing.
Arclight Audit & Appeals
Post-payment audit response and Medicare appeal support for wound-care providers facing overpayments, recoupments, contractor reviews, and ALJ-stage disputes.