The Big Picture of Physician Payment Within CMS The big picture is still playing out for physician...
Blog Posts by Caroline Fife, MD
The Lymphedema Treatment Act Passed!
The LTA will improve insurance coverage for the medically necessary, doctor-prescribed compression supplies that are the cornerstone of lymphedema treatment.
Medicare Posts Final Rule for 2024 Policy Changes to Medicare Advantage Plans – Review of Medical Necessity Requirements
Undersea and Hyperbaric Medicine IS a recognized medical subspecialty so that might help patients obtain necessary HBOT treatments.
Medicare Posts Final Rule for 2024 Policy Changes to Medicare Advantage Plans
The rule goes into effect Jan 1, 2024. Whether this will make MA less of a Medicare DIS-advantage is yet to be seen.
CMS Published 2023 Medicare/caid Health Care Providers’ Audit Process – Read Attorney Knicole Emanuel’s Offer to Clinicians Being Audited
Nearly every wound care and hyperbaric medicine practitioner is undergoing some sort of Medicare audit.
Wound Care Services and the Jimmo Settlement – Why it Matters to Patients Who Are in Palliative Wound Care
Unfortunately, some Medicare auditors are not following the law as it pertains to the presence or absence of a beneficiary’s potential for improvement.
Are Verbal Orders Prohibited?
There are no federal regulatory prohibitions on the use of verbal orders, although CMS frowns upon verbal orders in the context of medications.
Give Yourself the Gift of an Audit
A self-audit is a miserable “gift” to give yourself, but a real audit is a gift that just keeps on giving when you are not prepared.
Debunking Myths About Who Can Enter Information Into the Patients’ Medical Record
In its effort to debunk regulatory myths, the American Medical Association (AMA) has produced this useful fact sheet, “Who can document components of E/M services?”
Check Out the AMA Summary of the 2021 Rules for Billing E/M Visits by Time
The AMA reminds physicians that that there is no requirement to document the total time spent if the physician is not using time to calculate the level of service.
The AMA Debunks Myths Around Clinical Support Staff Documentation Inside EHRs
The American Medical Association (AMA) has been debunking several myths in a project called “Debunking Regulatory Myths.”
Reminder: 10 Days Until the Close of the 2022 MIPS Data Submission Period
The Centers for Medicare & Medicaid Services (CMS) has opened the data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in the 2022 performance year of the Quality Payment Program (QPP).
District Court Upholds ALJ’s Decision That Extrapolation Was Conducted in Error
A new post by attorney Knicole Emanual is vitally important for anyone under a Medicare audit.
Check Out This Article by Kathleen Schaum in Today’s Wound Clinic
Check out this article by Kathleen Schaum in Today’s Wound Clinic: Are You Prepared to Implement the 2023 CTP Final Rules?
Pandemic Emergency Declarations Scheduled to End May 11, 2023 – Check Out These CMS Resources
On January 30, 2023, the Biden-Harris Administration announced its intent to end the national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic on May 11, 2023.
Join the Fight with the Alliance of Wound Care Stakeholders
Are you feeling frustrated and helpless in the face of overwhelming regulatory burdens, capricious...
Check Out This Post: The Ugly Truth about Medicare Provider Appeals
The way these audits work, it’s assumed you are guilty and you have to prove you are not – in a one way conversation.
Documentation Requirements for Wound Care Services – Part 3
Not only do you need to document the goals of therapy, but you need to document whether your treatments are achieving them.
Documentation Requirements for Wound Care Services – Part 2
Healing does not have to be the goal, but if not, we had better state goals like, “getting the wound to a state in which the patient and family can care for it with only periodic physician assessment,” or “preventing progression and hospitalization.”
Documentation Requirements for Wound Care Services – Part 1
I am going to discuss the wound care policy that’s been in effect since 07/23/2020 for the Novitas jurisdiction.
CMS and CTPs (Cellular Tissue Products)
The full attention of every aspect of CMS is now focused on the use of CTPs. Why do you think that is?
The 2023 Medicare Physician Fee Schedule Proposed Rule is Out
Sweeping changes are proposed for cellular and/or tissue-based products (CTPs) when applied in the physician’s office.
RAC Provider Audits and Why You Need to Worry
If you want to know what topics the Centers for Medicare and Medicaid Services (CMS) are auditing,...
Homework from Audit Session One
Kathleen Schaum provided the first of 4 free sessions on "Keeping your Payment after an Audit."...
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 5
In case you think you are safe because you live in another MAC jurisdiction, it’s the same as the First Coast policy and it won’t surprise me to see all the MACs adopt the same (flawed) policies.
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 4
This is Part 4 of the list of what you need to document (per the proposed rule) if you want to use a skin substitute (CTP) for a DFU or VLU.
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 3
Novitas is going to limit clinicians to 2 applications of a “specific skin substitute” over the 12-week period defined by the date of the first application.
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 2
I am not even halfway through the details of the proposed policy, so stay tuned for more.
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 1
If you want to present comments on any of the proposed policies in the Novitas LCD, sign up to attend the Open Meeting.
The Department of Justice and the Drug Enforcement Agency Announce New Searchable Portals for “Guidance Documents”
This portal contains a single, searchable, indexed database that contains links to all DEA guidance documents.
A Simple Nutritional Algorithm for Patients with Chronic Wounds
I will be the first to admit that I did a bad job recognizing and treating nutritional deficits in...
CMS Rulings Are Not Law; Yet Followed By ALJs
As wound care begins to shift into the private doctor’s office – doctors are not going to be able to just may paybacks without a fight.
You said it Knicole! Stop Auditing Practitioners and Start Auditing Medicare Advantage Plans!
“Maybe it’s time to switch our telescopic lens from auditing providers to auditing MCOs and MAs. Let’s get these RAC, ZPIC, and TPE auditors focused on the stewards of our tax dollars, the prepaid entities.”
Wound care terminology & diagnosis codes haven’t changed since 1991, but wound care technology definitely has.
Take a Firsthand Look at a TPE (Targeted Probe & Educate) Audit
Dr. David Charash has just put out an article in Today’s Wound Clinic describing his experience with a TPE (Targeted Prove and Educate) audit. Check it out!
The MACs are Back… With TPE Audits
Targeted Probe and Educate (TPE) audits were briefly suspended for COVID-19, but now they are back.
The Future of Wound Infections – at the APWCA Meeting This Week in Philadelphia
Great opportunities to advance wound care knowledge, this week in Philadelphia!
Medicare and the Game of “Gotcha”
In this game, you may find out the rules only when someone gets a penalty.
CMS Releases the Final Rules of the Medicare Physician Fee Schedule and the Hospital Outpatient Payment System
CMS has released the final rules of the Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Payment System (HOPPS).
Free Access to a Review Article on the Development & Treatment of Lymphatic Dysfunction in Cancer Patients
Check out this Open Access review article on the development and treatment of lymphatic dysfunction in cancer patients.
Debridement Auditing – It’s All About the Benchmarking
Benchmarking allows you to visualize whether you might raise a red flag with an auditor, since we know they have been auditing debridement services.
The History of Medicare Administrative Contractor (MAC) Debridement Audits
The MACs have been auditing wound debridements. I thought it might be useful to understand the history of debridement audits.
New Study Highlights Risk Factors of Deep Tissue Injuries
Severe pressure injuries continue to occur at a predictable rate, particularly among critical care patients. There’s a reason.
The 2022 Physician Fee Schedule Proposed Rule is Open for Comment
These proposed “rules” are hundreds of pages and filled with jargon. However, the details will control how physicians get paid in 2022.
Food as Medicine
Let’s take a look at the ways in which proper nutrition can be an invaluable part of the wound healing process.
Life-Saving Tech Is Here, So Let’s Use It
It’s finally possible to have the tools you need for outpatient wound management seamlessly integrated into the hospital EHR.
Debridement Audits – What Documentation Is Required?
Proper documentation for surgical debridement is going to take a lot of engagement with your EHR vendor.