Blog Posts by Caroline Fife, MD

Check the 2023 Medicare data! Protect your NPI and don’t put hospital facility fees at risk.

 I will try to post a better analysis of the impact of these proposals in the HOPD (hopefully provided by readers who understand this better than I do).

When clinicians or management companies ask why a process must be done in a certain way, they are told, “It’s a regulatory requirement.”

There will no doubt be a significant response from manufacturers and clinicians in response to this proposal.

heir commitments reinforce the role of CMS in monitoring outcomes and promoting accountability.

Now may be the time for academic programs and large hospital systems that still provide needed emergency hyperbaric services to start contacting their congressmen.

Clinicians who reported data as part of the Quality Payment Program (QPP) in 2023 can preview their 2023 performance information before it appears on the Medicare.gov compare tool and in the Provider Data Catalog (PDC).

The stakes go beyond money: reputational harm, exclusion from Medicare and Medicaid, and even criminal charges are on the table.

Read the complete article for more details on what individual states are doing to push back on the use of AI in Prior Authorization.

The LCDs that will directly impact CTPs (Skin Subs) have been postponed until January 1, 2026! Announcement came at the last minute!

Be sure to read all of Ms. Emanuel’s article, which calls for radical reforms such as holding auditors accountable for mistakes.

Check out Knicole Emanuel’s recent blog post about CMS monetary recoupment before full adjudication.

While the Trump Administration may be reducing the regulatory burden in many areas of government, they are NOT reducing their focus on reducing on fraud investigations.

ACA insurers denied 1 in 5 medical claims in 2023, the highest rate since 2015.

I worry that the misbehavior of a small percentage of practitioners will reduce enthusiasm for a bill to fix a huge physician reimbursement problem.

The Noridian Provider Outreach and Education staff is hosting the Surgical Dressings webinar on 02/11/2025, 12:00 PM – 1:30 PM EST.

The American Medical Association (AMA) and the Illinois State Medical Society (ISMS) have filed a lawsuit in federal court.

The sad news is that CMS is going ahead with a 2.9% cut to Medicare physician reimbursements for 2025.

The short version, based on my cursory read, is that no old problems were fixed but no new problems were created by the final rule.

LCD – Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of Diabetic Foot Ulcers and Venous Leg Ulcers (L39756)

It would eliminate the 2.8% Medicare physician payment cut and provide a positive update that equals half of the Medicare Economic Index.

Self-disclosure is better than waiting to get caught. Lives can be ruined if you wait to get caught.

If practitioners encounter denials by auditors based on the use of note templates, they should probably seek legal counsel.

Check your scores soon as they will impact your 2025 Medicare payment!

The extreme and uncontrollable circumstances (EUC) policy will apply in affected Texas counties as identified by federal public health emergency and disaster declarations.

Mr. Bittinger’s article explains the various types of audits, what’s at stake, and how an attorney might help.

Wound Care practitioners who bill site of service 49 (independent clinic) take note!

In 2024, physicians had a 1.68% pay cut and they remain the only Medicare providers to not receive an inflationary update.

The billing of CTPs in the doctor’s office is unchanged. The 2025 Medicare conversion factor is set to decrease for the fifth straight year.

At first glance, there are no changes to Cellular Tissue Product /skin substitute payment, which remain under package pricing in this site of care.

CMS announced that Medicare payments under the Accelerated and Advance Payment (AAP) Program for the Change Healthcare/Optum Payment Disruption (CHOPD) will end on July 12.

The Centers for Medicare & Medicaid Services (CMS) added 76 new items and deleted three from its master list of durable medical equipment (DME), prosthetics, orthotics, and supplies.

CMS ALWAYS tell us what they are going to do before they do it. Then they do it, and we are surprised.

A 3.4% Medicare physician pay cut took effect on January 1, 2024. However, thanks to the passage...

CMS is encouraging MA plans to offer advance funding to health care professionals most affected by the cyberattack.

I am reposting the entire message from the CMS about the extension of the Extreme and Unavoidable...

Implementing the AUC program would have been a time consuming and expensive lift for practitioners.

There have been two major changes in the regulations pertaining to physician documentation during ambulatory visits, both of which are favorable for wound care practitioners.

I am a huge fan of attorney Knicole Emanuel’s blog and her most recent post is directly relevant to the field of wound care.