The Alliance of Wound Care Stakeholders has had another policy win! The Alliance met with the DME...
Update on the Surgical Dressing Policy – Thanks to the Alliance of Wound Care Stakeholders
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Welcome to the Intellicure Blog
Wound care updates and original insights
G2211 Documentation
Last month’s blog explained HCPCS G2211, its appropriate use, and inappropriate use. HCPCS G2211 -...
Resources from CMS and the AMA to Help You Implement Changes to Physician Documentation & Billing
There have been two major changes in the regulations pertaining to physician documentation during...
Medicare Audits on Pneumatic Compression & Surgical Dressings – “It’s About the Documentation…”
I am a huge fan of attorney Knicole Emanuel’s blog and her most recent post is directly relevant...
Be Careful Billing the New CMS G2211 Add-on Code for Visit Complexity
Beginning January 1, 2024, CMS is finalizing the implementation of a separate add-on payment...
Claims Disruptions Continue After Cyberattack on Change Healthcare
Change Healthcare – a healthcare technology company that is part of Optum and owned by...
Ransomeware Cyberattack on Change Healthcare is Affecting Individual Physician Practices Too
United Health-owned Change Healthcare has confirmed the ransomware group “ALPHV/Blackcat” is...
Noridian Has Begun Requesting “Documentation to Support Credentialing of the Provider Performing the HBO Service”
Contact us if you have received this request! This is a guest blog from Dr. Helen Gelly, who is a...
New Coding When Caring For a Complex Condition
HCPCS G2211 - Visit complexity inherent to evaluation and management associated with medical care...
CMS Final Rule on Prior Authorization Released
Prior authorization (PA) is costly, inefficient and responsible for patient care delays. The...
Surgical Dressing Webinar by Noridian on March 7th
On Thursday, Mar 7, 2024 from 12:00 PM - 1:00 PM CST, Noridian is offering a webinar on Surgical...
Noridian Offering Tutorials on Hyperbaric Oxygen Therapy (HBOT)
Noridian is offering two self-paced training tutorials to “assist providers and facilities in...
Novitas Releases Top Ten Reasons for Claims Denials…and Wound Centers Should Especially Check Out Reason #7
Novitas* released a list of the top 10 reasons for claims denials. Reason #7 for claim denials is...
MIPS Revenge!
2023 marked the 5th consecutive year of COVID-related MIPS exceptions that were either...
Noridian is Offering a Feb 13th Webinar on the Lymphedema Compression Benefit Category
On Tuesday, Feb 13, 2024 from 11:00 AM - 12:30 PM CST, Noridian is offering a Webinar for DME...
Pneumatic Compression Devices Webinar by Noridian on Feb 13th, 2024
On Tuesday, Feb 13, 2024 from 2:00 PM - 3:00 PM CST, Noridian is offering a webinar intended for...
The Deadline to Submit MIPS Data for 2023 is April 1 at 6 pm EST to Avoid up to a 9% Penalty on Medicare Revenue
The data submission period for Medicare’s Merit-Based Incentive Payment System (MIPS) 2023...
Time Sensitive! It’s Not Too Late to Sign the Letter to CMS Protesting the 41.5% Reduction of HBOT Facility Fees!
The response to the proposed 41.5% cut in the hospital facility fees for HBOT in 2024 has been...
CPT® Change for 2024
The 2024 CPT® code set1 takes effect January 1, 2024. There are major changes to CPT coding...
Without Warning – the Outpatient Prospective Payment Final Rule Cuts HBOT Facility Fees by 40%
Just so you have the info, it this blog post: Without Warning - the Outpatient Prospective Payment...
ICD-10 Changes
A new ICD-10 Clinical Modification (ICD-10-CM) code set took effect October 1, 2023. In this new...
Modifications Needed to Wound Center EHR to Support DME Orders for Dressings
There’s a lot of conversation about the way in which wound documentation determines whether a...
Mindfulness, Electronic Health Records and Ebola
The Centers for Disease Control (CDC) is warning doctors to watch out for cases of Marburg virus...
JZ Modifier Use With Skin Substitutes
CMS has issued guidance1 requiring the use of Modifier JW on all claims for biologicals from...
Observations About the 2024 PFS Pertaining to Cellular and/or Tissue-Based Products in the Doctor’s Office Setting
On July 13, 2023, CMS issued proposed rules for the 2024 Physician Fee Schedule (PFS) and the...
“Hidden RAC Audits” – Seriously…
Attorney Knicole Emanuel has posted a chilling blog on her site about hidden RAC (Recovery Audit...
Ulcer Debridement & Total Contact Cast Application
We cannot submit CPT®[1] coding for both ulcer debridement and total contact cast application when...
Listen to a Podcast with Dr. Helen Gelly, “How to Get Your Wound Clinic Through an Audit”
On your drive home, check out this podcast with Helen Gelly MD, FUHM, FACCWS, UHM/ABPM, “How to...
HBOT Facility Payments are Under Attack (Physician Supervision is Next…)
This blog post is directed at all physicians and allied health professionals involved in...
Check Out the Long List of CTPs (“Skin Subs”) Not Covered in the CGS, First Coast, & Novitas LCDs
Three Medicare Administrative Contractors (MACs) CGS Medicare, First Coast Service Option (FCSO)...
Highlights of the 2024 Outpatient Prospective Payment System (OPPS)
On July 13, 2023, CMS issued proposed rules for the 2024 Physician Fee Schedule (PFS) and the...
PRESS RELEASE: New Study in Journal of Medical Economics Shows Decrease in Chronic Wound Medicare Costs Amid Increase in Chronic Wound Prevalence
Over 2014-2019, the number of Medicare beneficiaries with chronic wounds increased 13% to 10.5...
New Surgical Treatment of Nails Policy
The Centers for Medicare and Medicaid Services (CMS) has implemented a nationwide policy...
Chiropractors Treating Diabetic Foot Ulcers?
It was bound to happen. Chiropractors have been offering “hyperbaric oxygen” treatments with...
Prior Authorization Nightmares & the Antidote to Burnout
This article just published in the “Intelligencer” resonated with me - "The Two Words That Can...
HIPAA Does NOT Require That Healthcare Providers Obtain Patient Authorization to Disclose Protected Health Information (PHI) to Other Clinicians for Treatment Purposes
Misconceptions about the HIPAA laws can negatively impact patient care and waste hours of staff...
Medicare Extrapolation Under 50% Error Rate? No Extrapolation ALLOWED!
I am a huge fan of attorney Knicole Emanuel’s legal blog, and the latest one is a must-read....
Thoughts on the ICD-10-CM 7th Character in the HOPD
As everyone knows by now, on October 1, 2015, entities covered by the Health Insurance Portability...
The Quality Payment Program and What it Means for the Future of Wound Management & HBOT
The Big Picture of Physician Payment Within CMS The big picture is still playing out for physician...
The Lymphedema Treatment Act Passed!
A staggering percentage of patients with chronic wounds have lymphedema. It’s a disease that every...
Medicare Posts Final Rule for 2024 Policy Changes to Medicare Advantage Plans – Review of Medical Necessity Requirements
Medicare has finalized its 2024 policies for the Medicare Advantage program. I have posted...
New CTP Coding Requirement
Effective July 1, 2023, providers must report the JZ modifier when the entire cellular and/or...
Medicare Posts Final Rule for 2024 Policy Changes to Medicare Advantage Plans
Medicare has finalized its 2024 policies for the Medicare Advantage program. I’ll post a few...
CMS Published 2023 Medicare/caid Health Care Providers’ Audit Process – Read Attorney Knicole Emanuel’s Offer to Clinicians Being Audited
I never miss attorney Knicole Emanuel’s blog posts. I have never met her and have no business or...
New Suture / Staple Removal CPT® Codes
Two new CPT®1 codes for 2023 represent suture / staple removal: CPT 15853: Removal of sutures...
Wound Care Services and the Jimmo Settlement – Why it Matters to Patients Who Are in Palliative Wound Care
Many patients have wounds that simply can’t be healed, and the goal of wound management is to...
Are Verbal Orders Prohibited?
There’s a common belief that The Centers for Medicare & Medicaid Services (CMS) and The Joint...
Give Yourself the Gift of an Audit
Attorney Knicole Emauel’s recent blog post encourages health care businesses to perform a self...
Debunking Myths About Who Can Enter Information Into the Patients’ Medical Record
As you are likely aware, on Jan. 1, 2021, Medicare requirements changed with regard to the billing...
Check Out the AMA Summary of the 2021 Rules for Billing E/M Visits by Time
The American Medical Association (AMA) has released a summary regarding the 2021 changes in...
The AMA Debunks Myths Around Clinical Support Staff Documentation Inside EHRs
There is a myth that clinical support staff such as nurses and medical assistants, are required to...
Expansion of Lymphedema Treatment
On November 1, CMS released the CY 2024 Final Home Health Prospective Payment System Final Rule....
Reminder: 10 Days Until the Close of the 2022 MIPS Data Submission Period
MIPS Eligible Clinicians Can Submit Their 2022 Data through March 31 The Centers for Medicare...
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...
Pandemic Emergency Declarations Scheduled to End May 11, 2023 – Check Out These CMS Resources
From Centers for Medicare & Medicaid Services (CMS): Public Health Emergency Resource Update...
More Exciting E&M Changes!
The process by which office and other outpatient evaluation and management (E&M) levels (CPT®...
Join the Fight with the Alliance of Wound Care Stakeholders
Are you feeling frustrated and helpless in the face of overwhelming regulatory burdens, capricious...
Consolidation of E&M Services in 2023
Effective January 1, 2023[1], under the guidance of the AMA CPT Editorial Panel, many evaluation...
Check Out This Post: The Ugly Truth about Medicare Provider Appeals
Once again attorney Knicole Emanuel has posted a chilling blog about Medicare provider appeals....
Documentation Requirements for Wound Care Services – Part 3
Many Medicare Administrative Contractors (MACs) have policies currently in place that govern...
Documentation Requirements for Wound Care Services – Part 2
Many Medicare Administrative Contractors (MACs) have policies currently in place that govern...
Documentation Requirements for Wound Care Services – Part 1
Many Medicare Administrative Contractors (MACs) have policies currently in place that govern...
CMS and CTPs (Cellular Tissue Products)
Medicare’s traditional “fee for service” (FFS) program is administered through several private...
Place of Service for “Observation” Status Patients
When it comes to coding are “Observation” patients inpatients? No. Medicare considers observation...
The 2023 Medicare Physician Fee Schedule Proposed Rule is Out
The 2023 Medicare Physician Fee Schedule (CMS-1770-P) went on display late afternoon July 7, 2023....
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,...
The Importance of CPT® 99024
CPT 99024 -- Postoperative follow-up visit, normally included in the surgical package, to indicate...
Watch Session 4 of the Intellicure Webinar Series: Keeping Your Payments — After An Audit — Is In Your Control
On Wed., Oct. 26, Dr. Caroline Fife and Kathleen D. Schaum presented the fourth and final session...
Watch Session 3 of the Intellicure Webinar Series: Keeping Your Payments — After An Audit — Is In Your Control
On Wed., Oct. 19, Dr. Caroline Fife and Kathleen D. Schaum presented the third session of...
Watch Session 2 of the Intellicure Webinar Series: Keeping Your Payments — After An Audit — Is In Your Control
On Wed., Oct. 5, Dr. Caroline Fife and Kathleen D. Schaum presented the second session of...
Homework from Audit Session One
Kathleen Schaum provided the first of 4 free sessions on "Keeping your Payment after an Audit."...
Watch Session 1 of the Intellicure Webinar Series: Keeping Your Payments — After An Audit — Is In Your Control
On Wed., Sept. 28, Dr. Caroline Fife and Kathleen D. Schaum held the first session of...
Join Our Integral 4-Part Webinar Series on Audits!
Please join Dr. Caroline Fife and Kathleen D. Schaum as they discuss the keys to keeping your...
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 5
Novitas has issued a draft Local Coverage Determination (LCD) for the use of “skin substitutes”...
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 4
Novitas has issued a draft Local Coverage Determination (LCD) for the use of “skin substitutes”...
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 3
Novitas has issued a draft Local Coverage Determination (LCD) for the use of “skin substitutes”...
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 2
Novitas has issued a draft Local Coverage Determination (LCD) for the use of “skin substitutes”...
The Devil in the Documentation Details of the Proposed Novitas LCD on “Skin Substitutes” – Part 1
Novitas and First Coast have issued draft Local Coverage Determinations (LCDs) that are...
The Department of Justice and the Drug Enforcement Agency Announce New Searchable Portals for “Guidance Documents”
As a result of Executive Order 13891 (E.O. 13891), Promoting the Rule of Law Through Improved...
Zero Day Postoperative Global Periods
CPT® 28820 - Amputation, toe; metatarsophalangeal joint CPT® 28825 - Amputation, toe;...
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
I often feel that I have gone through the looking glass with Alice when it comes to the behavior...
Wound Repair CPT® Codes
Repair Codes When it comes to CPT® coding, wound repair is typically classified as simple,...
Pressure Ulcer Versus Pressure Injury ICD-10-CM Coding
It must be admitted that the terminology for pressure related skin problems is a mess. The...
You said it Knicole! Stop Auditing Practitioners and Start Auditing Medicare Advantage Plans!
I am fan of attorney Knicole Emanuel’s blog and this one is worth the read. We are being audited...
Is Collagen Billable Following Elective Procedures?
Probably not, but it depends. Some providers dispense surgical dressings to patients and submit...
Documenting “Wulcers”
In about 1991 when I was on the faculty of the University of Texas Health Science Center in...
Take a Firsthand Look at a TPE (Targeted Probe & Educate) Audit
Dr. David Charash put out an article in Today’s Wound Clinic describing his experience with a TPE...
Don’t Miss Dr. Fife’s Sessions, Intellicure’s Interactive Booth at SAWC
This week is the big Spring SAWC (Symposium on Advanced Wound Care) conference! Intellicure...
General Confusion About Hyperbaric Oxygen Therapy Chamber Supervision (and the Pandemic)
Recently, a Hyperbaric Medicine physician asked for clarification on the supervision requirements...
Can Specialists Submit CPT® 99304?
Yes, specialists who are not the admitting / primary physician may submit CPT 99304 in certain...
The FDA Updates Its List of Conditions for Which HBOT Chambers are Cleared for Use
Hyperbaric oxygen chambers are classified by the US Food and Drug Administration (FDA) as “Class...
Appropriate Use of CPT® 11755
CPT® 11755 - Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail...
The MACs are Back… With TPE Audits
The MACs are back at it with the Targeted Probe and Educate (TPE) audits. TPEs were briefly...
The Future of Wound Infections – at the APWCA Meeting This Week in Philadelphia
Great opportunities to advance wound care knowledge, this week in Philadelphia! Wound Week™ 2022...
Medicare and the Game of “Gotcha”
I am a devoted follower of Knicole Emanuel’s legal blog, which focuses on Medicare and Medicaid....
Coding During the Postoperative Global Period
Many wound care–related procedures, including some amputations and certain incision and drainage...
CMS Releases the Final Rules of the Medicare Physician Fee Schedule and the Hospital Outpatient Payment System
The Centers for Medicare and Medicaid Services (CMS) has released the final rules of the Medicare...
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...
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