Chronic wounds affect more than 8.2 million Medicare beneficiaries annually, according to the Centers for Medicare and Medicaid Services (CMS), generating more than $96 billion in annual treatment costs. Wound care centers and outpatient hyperbaric oxygen (HBO) therapy programs serve some of the most clinically complex patients in outpatient medicine — diabetic foot ulcers, venous leg ulcers, radiation tissue damage, and refractory osteomyelitis — and the administrative demands that accompany these patients are equally complex.
The Authorization Burden in Wound Care
Hyperbaric oxygen therapy is subject to stringent CMS coverage criteria under NCD 20.29, requiring documented wound non-improvement despite 30 days of standard care before HBO authorization is granted. Commercial payers add their own layers of documentation requirements, peer-to-peer review opportunities, and session-by-session authorization limits. A patient undergoing a standard 20 to 40 session HBO course may require multiple separate authorization requests as sessions are exhausted, creating a near-continuous authorization management workflow for a busy program.
The American College of Hyperbaric Medicine (ACHM) estimates that authorization-related administrative tasks consume an average of 2.5 staff hours per HBO patient per month in programs without dedicated administrative support — time that wound care nurses and hyperbaric technicians are often absorbing on top of clinical duties.
What a Virtual Assistant Handles
Wound care and HBO VAs work within platforms such as WoundExpert, Tissue Analytics, or hospital-integrated EMRs, alongside payer portals and referral management tools. Their primary responsibilities include:
Referral intake and triage. Inbound referrals from primary care, vascular surgery, endocrinology, and podiatry must be logged, insurance coverage confirmed, and appointment types assigned — outpatient wound clinic visit versus HBO consultation versus both. The VA contacts referring offices to obtain wound photography, recent labs, and prior treatment documentation required for authorization.
HBO prior authorization. The VA assembles the CMS-required documentation packet for each HBO candidate: wound measurement records, evidence of 30-day standard-care trial, wound etiology documentation, and physician attestation. Authorization requests are submitted, approval tracking is maintained in a dedicated log, and peer-to-peer calls are scheduled promptly when payers issue initial denials.
Treatment scheduling. HBO sessions are typically prescribed five days per week. The VA manages the hyperbaric chamber schedule, confirms daily session slots with patients, handles rescheduling requests, and maintains a fill list to minimize unused chamber time when cancellations occur.
Referral source communication. Wound care programs depend on consistent referral pipelines from primary care, podiatry, and vascular surgery. The VA sends monthly outcome updates and thank-you communications to top referring providers, maintaining the relationships that drive new patient volume.
Insurance follow-up and denial management. When claims are denied, the VA logs the denial reason, collects the appeal documentation requested by the payer, and coordinates with the billing team to file appeals within filing deadlines.
Financial Impact of VA Support
MGMA data shows that wound care programs operating within hospital outpatient departments carry front-office labor costs of $48,000 to $60,000 per FTE annually. Independent wound care centers and free-standing HBO programs that engage VAs for referral and authorization work report reducing their administrative labor costs by 25 to 35 percent without reducing throughput capacity. In a program running 40 to 60 active HBO patients, that savings typically more than covers the cost of full-time VA support.
Implementation Approach
The most effective wound care VA integrations begin with authorization workflows — the highest-complexity, highest-impact function — before expanding to scheduling and referral communication. Practices should create authorization checklists for each major payer and wound indication during the first two weeks of VA onboarding, establishing standardized workflows that reduce errors and turnaround time.
Connect with a healthcare virtual assistant at Stealth Agents to find a wound care and hyperbaric VA trained in CMS authorization requirements and referral coordination.
Sources
- Centers for Medicare and Medicaid Services (CMS), Chronic Wound Expenditure Data, 2025
- CMS National Coverage Determination 20.29, Hyperbaric Oxygen Therapy, 2025
- American College of Hyperbaric Medicine (ACHM), Administrative Burden Survey, 2025
- Medical Group Management Association (MGMA), Outpatient Program Labor Cost Benchmarks, 2025