Are you feeling frustrated and helpless in the face of overwhelming regulatory burdens, capricious...
Blog Posts by Caroline Fife, MD
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.”
Documenting “Wulcers”
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.
Caroline Fife, MD
Dr. Fife is Co-Founder and Chief Medical Officer of Intellicure, Executive Director of the US Wound Registry, and Editor of Today’s Wound Clinic.