Check Out Jay Shah’s Podcast, “Let Doctors Be Doctors,” About Wound Care in the Rio Grande Valley (with Noel Oliveria)
“People heard…and they started just showing up on the doorstep…I’m telling you, honestly, I’ve not had a slow day since we have opened the doors.”
CAMPs vs. Health and Human Services – Judge Dismisses the Case Again
The second lawsuit challenging the skin substitute reimbursement provisions of the CY 2026 Medicare Physician Fee Schedule (PFS) final rule has been overturned.
New Report: The Skin Sub Overage Paradox
Intellicure Analytics has released a new report examining what happened to skin substitute sizing...
Attend the Virtual Lymphedema Seminar on October 3rd
You don’t want to miss Dr. Eva Sevick’s presentation, “Update on Research of Developing Lymphatics in the Brain.”
Negative Pressure Wound Therapy Indications: A Clinical Guide for Wound Care Providers
This clinical guide breaks down the evidence-based Negative Pressure Wound Therapy Indications wound care providers need to make confident treatment decisions — covering wound type selection, physiological rationale, and payer documentation requirements. It equips clinicians to apply NPWT appropriately, maximizing healing outcomes while minimizing compliance risk.
Nevada Doctor Charged with $95 Million in Wound Care Fraud
The Department of Justice (DOJ) announced an indictment of a Nevada wound care physician for fraud in relation to expensive amniotic allografts.
Wound Care Quality Outcome Metrics: What They Are and Why They Matter for Your Practice
Wound care quality outcome metrics have become the primary language through which practices prove their clinical value to payers, CMS, and accreditation bodies under value-based reimbursement. This article breaks down which metrics matter most, how they tie into MIPS and QCDR reporting requirements, and how purpose-built wound care technology makes measurement actionable rather than a burden.
Wound Care Billing and Coding Best Practices: A Step-by-Step Guide for Clinicians
This step-by-step guide to wound care billing and coding best practices walks wound care physicians, clinic administrators, and billing teams through documentation structure, CPT code selection, modifier rules, ICD-10 pairing, claim scrubbing, and denial management. Whether you operate a hospital-based wound center or an independent clinic, these principles provide a clear, repeatable process for maximizing first-pass claim acceptance and improving revenue cycle performance.
7 Key Strategies for Choosing Between Smart Dressings and Traditional Wound Dressings
This article equips wound care clinicians with 7 data-driven strategies for choosing between smart dressings vs traditional wound dressings, covering wound complexity, practice infrastructure, reimbursement, and documentation requirements. Rather than treating the decision as binary, it provides a nuanced, patient-centered framework that helps practitioners deploy each dressing category effectively to optimize healing outcomes and compliance.
Are Amniotics Experimental – Like Medicare Auditors Say They Are?
Here are few examples of your letters around claim denials due to the “experimental” nature of [certain] amniotic products.
Check Out Attorney Knicole Emanuel’s Post About Escalating Medicare Provider Audits to Federal District Court
Attorney Knicole Emanuel has posted a blog explaining that under some circumstances, an appeals case can be escalated to a Federal District Court.
CMS Has Quietly Reopened the Skin Substitute Evidence Door
Subscribers to CMS listservs got a very short email announcing that CMS is reopening the call for clinical evidence on skin substitutes.
The Physician Fee Schedule Proposed Rule is Out!
CMS is inviting comments on all these proposals and it is easy for you to make your voice heard during the comment period.
This Tuesday July 21 – Watch the Livestream Roundtable: Medicare Fraud: Examining the Explosive Growth in Skin Substitute Spending
The Subcommittee on Health Care and Financial Services Chairman Glenn Grothman (R-Wis.) announced a roundtable on “Medicare Fraud: Examining the Explosive Growth in Skin Substitute Spending”.
The Medicare GLP-1 Bridge: The Medicare Demonstration Program to Provide GLP-1 Medications for Obesity at $50 per Month Began July 1, 2026
Until now, Medicare has not covered drugs for weight loss. That changed on July 1.
The Skin Substitute Lawsuit, Round Two: Guest blog by Dr. Ryan Mathis
The legal fight over how Medicare pays for skin substitutes is back in court! Here’s a guest blog by Dr. Ryan Mathis to explain it.
CMS Just Released the OPPS Proposed Rule and the Skin Substitute Payment Rate Stayed the Same!
Just in time for the 4th of July holiday! CMS just released the Hospital Outpatient Prospective Payment proposed rule!
A Brief Look at the Proposed Provider Reimbursement Stability Act of 2026 (H.R. 8163)
Passage of this legislation would be best coupled with one permanently tying Medicare physician payment to the MEI.
Medicare, MIPS, Payment Cuts, Quality Measures and a Bipartisan Bill to Fix the Mess
MIPS could work, if US Wound Registry wound care relevant quality measures were available in every electronic health record (EHR).
Your Comments on Cellular Tissue Product / Skin Substitute Audits
…”now that skin sub manufacturers’ revenue has plummeted, support for clinical research (with a few notable exceptions) has plummeted.”
Medicare Auditors Are Not Wound Care Specialists: Why Providers Win Appeals When the Full Story Finally Gets Read – Blog Post by Knicole Emanuel
We will have to wait to find out if audits will lessen now that the new pricing structure has dramatically decreased the monetary incentive for audits.
Saving Lives and Limbs: What a Major New Systematic Review Means for HBOT Practitioners and Patients
A landmark systematic review has been completed which concludes that that HBOT may be one of the most important tools we have for tissue ischemia patients.
Commercial Blue Cross and Blue Shield of Texas (BCBSTX) May Downcode E/M Services Based on Automated Claims Review – Intellicure Can Help protect you
Blue Cross and Blue Shield of Texas will “enhance” its claims editing and review process for office, inpatient, and outpatient evaluation and management (E/M) services for patients in commercial plans.
Preview Your 2024 MIPS Data on the CMS Website Through Thursday, June 11
Physicians who submitted 2024 performance data in MIPS can preview that information through Thursday, June 11, at 8 pm ET on the QPP website.
An Update on the CAMPS Legal Initiative to Reverse Skin Substitute Payment Pricing – Guest Blog by Dr. Ryan Mathis
The deadline for the CAMPs Initiative to appeal the court’s decision was May 11, 2026. Here’s an update about what happened by Dr. Mathis.
UnitedHealth and CVS Health Announce Progress Toward Standardizing the Process for Prior Authorization Requests
UnitedHealth and CVS Health announced that they have standardized data and submission requirements for more than half their prior authorizations (PAs).
CMS Launches Newsletter to Help Small Practices (15 or Fewer Clinicians) Understand MIPS and the Quality Payment Program
2026 is the 6th year that practitioners could lose up to 9% of their Medicare claims under MIPS.
TMA Raises Awareness About Drug Access Limitations by Pharmacy Benefit Plans – Guest Blog by Dr. Jay Shah
Dr. Jay Shah, President of the Texas Medical Association (TMA) has provided this guest blog about what the TMA is doing to monitor the issue of pharmacy benefit plan limitations on drug access.
Trouble with Medicare “Dis” Advantage Programs? CMS has a Provider Complaint Form
The update represents a formalized mechanism for providers to raise concerns directly with CMS regarding Medicare Advantage plans.
Telehealth & Remote Monitoring Billing & Payment
CMS released an updated Medicare Learning Network (MLN) publication outlining 2026 changes.
New Medicare Advantage Complaints Process
On December 22, 2025, CMS implemented an online form on cms.gov for providers that need to report a complaint about a Medicare Advantage plan.
Off-Campus HOPDs Need a Separate NPI – Is This a Prelude to Site Neutrality? (Guest Blog by Dr. Helen Gelly)
MEDPAC has been recommending site neutrality for decades, and perhaps the powers that be at CMS are listening.
How is Medicare Prior Authorization Going for You Under WISeR in Texas? Dr. Shah of the TMA Wants to Know!
This is a rare and wonderful opportunity to have your voice heard by a powerful state medical association (with a president who is a wound care expert!)
How a Non-Pressure Ulcer Cost Measure Could Help or Hurt Your MIPS Score (and Your Medicare Payments)
CMS is going to create a wound-relevant cost measure no matter what. Let’s make sure it is as accurate and fair as possible.
Just Released! “Wound Care at Home: A Guide for Families and Caregivers”
It’s a wonderful guide for which provides instructions and explanations, and which answers the questions that patients are often afraid to ask.
Part One of My Interview on CTP Changes is Now Available on HMP Global Learning Network/Wounds
On Jan. 8, 2026, HMP posted the first part of my interview on “The Impact of CTP Changes on Provider Types.”
What We Need Next is a ZIP Code Rosetta Stone for Wound Care Outcomes
It is time to use already available ZIP code information to alert healthcare practitioners of community risk factors.
Texas Medical Association (TMA) resources for the new WISeR prior authorization program affecting CTP/skin subs
The Texas Medical Association (TMA) has a new education sheet to guide clinicians through services...
In 2026, Monetary Threshold is Higher for Medicare’s Expedited Access to Judicial Review (EAJR)
I hope those of you who are experts at the appeals process will provide some information in a guest blog about the EAJR process.
Step-by-Step Instructions on How to Download Your Field Test
CMS has posted the Cost Measure Field Test reports on the QPP website! It’s time for you to download yours!
CMS Press Release: Prepare for 2026 Field Testing of Episode-Based Cost Measures
Field Test Reports for eligible clinicians and clinician groups will be available on the Quality Payment Program Portal beginning January 29.
How to Prepare For & Make the Most of Your Field Test – Attend CMS Meetings on Jan 27 and Feb 18
CMS is holding office hours with specialty societies and organizations to provide information about the upcoming field testing period.
Here We Go Again: CMS is Testing a New “Non-Pressure Ulcer” Cost Measure
I will be posting a series of blogs explaining this in more painful detail, including a step by step guide to download your Field Test report.
Noridian Webinar Materials on Wasteful and Inappropriate Service Reduction (WISeR) Model
I attended the Noridian informational call on the Wasteful and Inappropriate Service Reduction (WISeR) model.
Breaking News! Medicare Will Not Pay for CTP / Skin Substitute Wastage “Under Any Circumstances”
Medicare fee for service (FFS) does not pay for discarded amounts of “incident to supplies” (which is how all non-BLA CTPs/skin subs are now classified) and will only pay for the amount of product furnished.
A New Era for Cellular Tissue Products / Skin Substitutes
Price controls are better for patients, Accountable Care Organizations, secondary insurers, tax payers, and the Medicare trust fund.
Breaking news! Cellular Tissue Products (CTPs) / CAMPS to be Paid at $127.28/cm2
Breaking news! Physician fee schedule finalized: CTPs/CAMPS priced at ~$127.28/cm2. Read more...
Check Out the Editorial in Med Page Today: 2 Doctors Concerned About Improper Use of Skin Substitutes
On October 8th, Med Page Today published an opinion piece about the increasing improper use of skin substitutes in chronic wounds.
Pyoderma Gangrenosum Nonprofit Kickoff Meetings “ALL THINGS PG”
There is a new, non-profit Patient and Family Advisory Council for Pyoderma Gangrenosum.
Cellular Tissue Products / Skin Substitute Applications in the Home Setting – Check Out Kathleen Schaum’s Recent Article in Advances in Skin and Wound Care
The application of a Cellular Tissue Product (CTP) / skin substitute, a surgical procedure, is out of the scope of a registered nurse.