Today the Department of Justice (DOJ) held a press conference led by Dr. Mehmet Oz, the...
BREAKING NEWS in the DOJ Press Conference! More Skin Substitute / Cellular Tissue Product (CTP) Fraud Indictments
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Welcome to the Intellicure Blog
Wound care updates and original insights
Site Neutrality – a Looming Disaster or an Opportunity?
There’s a new article in Health Affairs about “site neutral” payments that could change everything...
The Quality Payment Program (QPP) “Doctors and Clinicians Preview Period” for 2023 is Officially Open
Preview your performance before it is public The “Doctors and Clinicians Preview Period” is...
DOJ Unveils a New Corporate Enforcement & Voluntary Self-Disclosure Policy (CEP)
Last week, the Head of the Justice Department’s Criminal Division, Matthew R. Galeotti, delivered...
Providers Under Siege
According to the US Department of Justice (DOJ) Civil Division, many of the Fraud Section’s cases...
States Try to Limit the Use of AI in Prior Authorization
Stateline reports health insurance companies are facing “scrutiny for allegedly using artificial...
CTP-related LCDs Postponed at the Last Minute!
The Local Coverage Determinations (LCDs) that will directly impact the application and...
Overzealous Medicare Audits
Here’s another fantastic post from attorney Knicole Emanuel about the serious overreach problems...
Hospitals & Doctors Spend a Lot of Money Just Trying to Get Paid
A 2/26 article in Chief Healthcare Executive entitled "Hospitals, providers spent $25B on battles...
What Happened to “Innocent Until Proven Guilty? Check Out this Article on Medicare Recoupment
Check out Knicole Emanuel’s recent blog post about CMS monetary recoupment before full...
Fewer Regulatory Hoops but Continued Scrutiny on Fraud Under the Trump Administration
Check out another insightful blog by healthcare attorney Knicole Emanuel, "Trump’s...
The Cigna Group Launches Actions to “Drive Positive Change for Customers & Patients”
After the outpouring of public anger at the health insurance industry following the shooting of...
ACA Healthcare Plan “Just Say No” to 1 in 5 Claims
The Kaiser Family Foundation (KFF) has released a report on claims denials and appeals in the ACA...
Murphy Introduces Bipartisan Legislation to Preserve Medicare for Patients and Physicians
On January 1, 2025, a 2.83% Medicare reimbursement cut went into effect for physicians due to a...
A Titanic Shift at CMS: The Push to Trim Administrative Costs & Increase Audits – Knicole Emanuel’s Recent Post
Attorney Knicole Emanuel has an interesting blog post about DOGE and CMS. CMS has over 6,000...
“Defending Against Medicare and Medicaid Audits: A Guide for Healthcare Providers” by Knicole Emanuel
Check out attorney Knicole Emanuel’s recent blog, “Defending Against Medicare and Medicaid Audits:...
Noridian Surgical Dressings Webinar – 02/11/2025
Getting surgical dressings for patients can be very difficult. The documentation required is...
Landmark Antitrust Settlement Calls for Blue Cross Blue Shield to Pay $2.8 Billion into a Fund Designated for Physicians and Others
A U.S. District Court in Alabama has given preliminary approval to a landmark antitrust settlement...
LCDs Delayed Until April 13, 2025
CMS has indeed delayed the implementation date for the Skin Substitute Grafts/ Cellular and...
American Relief Act Extends Some Telehealth Waivers Including Audio-Only Telehealth
Telehealth waivers, originally instituted during the COVID-19 public health emergency and...
BREAKING NEWS: Wound Care Company Owners Plead Guilty to $1.2 B in Fraudulent Claims for Amniotic Products and Face Prison
Office of Public Affairs | Arizona Couple Pleads Guilty to $1.2B Health Care Fraud | United States...
Physicians Have Concerns Over the Implementation of Medicare’s Add-on Code for Complex Care (G2211)
Most patients with chronic non-healing wounds have multiple medical conditions, and the physicians...
Changes to the Administrative False Claims Act (AFCA) Mean That “Smaller” Medicare Fraud Cases (Up to $1 Million) Can Be More Easily Prosecuted
Check out attorney Knicole Emanual’s new blog post about new legislation making it easier for the...
The New LCDs are (Almost Certainly) Coming to Town
On December 10th, the Medicare Administrative Contactors (MACs) held a virtual Town Hall meeting...
CGS Chief Medical Officer is Hosting a Meeting on the New Cellular Tissue Product / Skin Substitute LCD on December 20th
CGS J15 Webinar on Skin Substitute Grafts/Cellular and Tissue-Based Products for the Treatment of...
AMA sues MultiPlan Alleging Price-Fixing for Out-of-Network Physician Payments
On October 24th, the American Medical Association (AMA) and the Illinois State Medical Society...
CMS Releases the Medicare Physician Fee Schedule Final Rule for 2025
CMS has published the final rule for the CY2025 Medicare Physician Fee Schedule (MPFS). As we knew...
ICD-10 Changes
Every year, a new ICD-10 Clinical Modification (ICD-10-CM) code set is released which takes effect...
CMS Releases 2025 Final Rule for the Hospital Outpatient Prospective Payment System (OPPS)
CMS has released the CY 2025 Final Rule for the Hospital Outpatient Prospective Payment System...
Breaking News! LCDs for Cellular Tissue Products / Skin Substitutes Released!
Read them here (more to come): [pdf-embedder...
Bipartisan Bill Introduced That Would Provide a 4.7% Medicare Physician Payment Update
A bipartisan group in the US House of Representatives introduced a bill that would provide a 4.7%...
FDA Approves Changing the Expiration Date of Some IV Fluids Made by Baxter to Help Alleviate Shortages
In the wake of shortages made worse by Hurricane Helene, the Food and Drug Administration (FDA)...
Check Your Final 2023 MIPS Scores Available Online – Scores Will Impact 2025 Physician Payment!
Check your final MIPS scores for the 2023 performance year, available on the QPP website. Should...
“To Self-Disclose or Not to Self-Disclose”: Check Out Attorney Knicole Emanuel’s Blog
To Self-Disclose or Not to Self-Disclose! | medicaidlaw-nc (medicaidlawnc.com) Healthcare attorney...
Templated Notes and Medicare Audits
A recent blog by Knicole Emanuel discussed the issue of templated notes and Medicare audits....
Loss of Baxter Facility in N.C. from Helene is Affecting Availability of IV Solution and Shortages May Worsen Due to Hurricane Milton
Hospitals are facing shortages of IV fluids following Hurricane Helene’s damage to Baxter...
Reminder: Final Scores for the 2023 Performance Year of Medicare’s Merit-Based Incentive Payment System (MIPS) are Now Available Online and the Deadline to Request a Review is October 11 at 8 PM ET
Check your scores soon as they will impact your 2025 Medicare payment! Should an error be found,...
UnitedHealthcare Launches a “Gold Card” Program in October to (Hopefully) Reduce Prior Authorization Woes
UnitedHealthcare plans to launch a program in October geared toward streamlining prior...
Due to the Impact of Beryl, CMS Has Automatically Applied a Hardship Exemption Within the 2024 Merit-Based Incentive Payment System (MIPS) Performance Period to Eligible cC Areas
Due to the impact of Hurricane Beryl on Texas physician practices, the Centers for Medicare &...
Check Out the New Article in TWC “I’m Getting Audited – Now What?” by Stephen Bittinger
Check out this article, "I'm Getting Audited - Now What?" by attorney Stephen Bittinger, a partner...
Aetna to Cut Payment for Urgent Care Surgical Services and Payments for NPs and PAs
Starting Sept. 1, Aetna will pay 75% of the contracted rate for surgical procedures performed in...
The Average Cyberattack Breach Costs ~$11 Million – and the Number of Attacks Per Week is Increasing
An article in Healthcare Finance News reports that, “The global health care sector experienced a...
In 2025, Physicians Face a 2.8% Pay Cut While Mandatory Participation in an MVP Looms
For the fifth year in a row, the 2025 CMS Medicare Physician Fee Schedule (MPFS) forecasts a...
Does Which EHR a Doctor Uses Impact the “Cost” Category of MIPS?
Someone emailed me a very interesting question about MIPS performance. By way of background, the...
Noridian and CGS Release FAQs on Lymphedema Compression Treatment Items
Noridian and CGS Provider Outreach and Education have released the most frequently asked questions...
Health Information Technology Proposed Rule (HTI-2) is Out
The U.S. Department of Health and Human Services (HHS), through the Office of the National...
Global Internet Outage Continues to Impact Many Healthcare Systems
A global internet outage which began Friday continues to impact many hospitals as well as banking...
2025 Medicare Physician Fee Schedule is Out (and CMS Did Not “Package Price” Cellular Tissue Products / Skin Substitutes in the Doctor’s Office)
The Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2025...
Breaking News! OPPS Proposed Rule is Out!
The Outpatient Prospective Payment System (OPPS) proposed rule has come out! It will take time to...
Accelerated and Advance Payment (AAP) for Medicare Ends on July 12
The Biden administration announced the termination of a program that provided more than $2.55...
CMS Adds 76 New Items to its Master List of DME Supplies That May Be Subject to Prior Authorization (and Some Surgical Dressings are on the List)
The Centers for Medicare & Medicaid Services (CMS) added 76 new items and deleted three from...
How the DEA is Working to Help Communities Get Rid of Unused or Expired Prescription Medications
That drawer or cabinet of old medications can be dangerous. However, it’s hard to know what to do...
How to Subscribe to the NGS Self Service Plus Newsletter
It’s always a good idea to subscribe to the email list serve of your Medicare Administrative...
Physicians Have Until Dec. 31 to File a MIPS Hardship Exemption Due to the Change Cyberattack
Due to the ongoing impact of the Change Healthcare cyberattack on physician practices, the Centers...
Skin Substitute Proposals: What You Can Do
On April 25, 2024 all seven Part B MACs released proposed policies that would govern the...
What Doctors Wish Patients Knew About Prior Authorization
What doctors wish patients knew about prior authorization | American Medical Association...
Pneumatic Compression Devices Are in the Spotlight for 2024 Audits
Check out the article by attorney Knicole Emanuel just posted in Today’s Wound Clinic: Pneumatic...
CMS Explains its 2024 Value-Based Care Strategy
A new CMS blog entitled "Update on the Medicare Value-Based Care Strategy: Alignment, Growth,...
A Little Reprieve for Physician Pay Cuts
A 3.4% Medicare physician pay cut took effect on January 1, 2024. However, thanks to the passage...
MIPS Quality Measure #130 Documentation
MIPS Quality Measure ID #130, “Documentation of Current Medications in the Medical Record” carries...
CMS Announces Flexibilities in the Wake of the Change Cyberattack
Federal officials have announced several flexibilities to help physicians in the wake of the...
CMS Announces Reopening of 2023 MIPS EUC Application in Response to Change Healthcare Cyberattack
I am reposting the entire message from the CMS about the extension of the Extreme and Unavoidable...
CMS Removes the Requirement for AUC From the 2024 Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) has yielded to pressure and removed the...
Update on the Surgical Dressing Policy – Thanks to the Alliance of Wound Care Stakeholders
The Alliance of Wound Care Stakeholders has had another policy win! The Alliance met with the DME...
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....
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