The cost of care for home health clients with complicated wounds frequently exceeds reimbursement received from Medicare and other payer sources. As a result, home health agencies may be reluctant to accept this type of referral. Many of the costs associated with complex wound care can be substantially reduced by appropriate use of expensive therapies and dressings and establishment of a cost-effective wound care formulary. Costs can also be reduced by collaboration with prescribing providers to ensure that orders are written generically, and avoid unnecessary nursing visits. Knowledgeable WOC nurses can play a critical role in coordinating care that is both clinically and fiscally effective. This article reviews common challenges in caring for complex wounds in the home care setting with a focus on strategies the prescribing provider and wound care clinician can use to optimize outcomes.