by Caroline Fife, M.D. | Aug 14, 2025 | Fight the Good Fight, Healthcare Payment Policy
White House, Tech Leaders Commit to Create Patient-Centric Healthcare Ecosystem | CMS Health Technology Ecosystem | CMS “For decades, bureaucrats and entrenched interests buried health data and blocked patients from taking control of their health,” said HHS Secretary...
by Caroline Fife, M.D. | Aug 12, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Attorney Knicole Emanuel’s most recent blog post is about Medicare audits focused on the use of “skin substitutes” by Recovery Audit Contractors (RACs) and Unified Program Integrity Contractors (UPICs). The proposed skin substitute LCD(s) may be on hold, but that has...
by Caroline Fife, M.D. | Aug 4, 2025 | Hyperbaric Oxygen Therapy
Rest remains the standard treatment for concussions in young athletes. However, worrisome data continues to accumulate around the short- and the long-term effects of even mild concussions among young people. Hyperbaric oxygen therapy may offer symptomatic relief of...
by Caroline Fife, M.D. | Aug 1, 2025 | Miscellaneous Musings
6 fantastic novels doctors recommend for your summer reading list | American Medical Association The American Medical Association (AMA) recommends reading novels as a way to reduce physician burnout. I have read most of the books on the AMA’s list of great fiction and...
by Caroline Fife, M.D. | Jul 30, 2025 | Fight the Good Fight, Healthcare Payment Policy
I should leave the coverage interpretation to the professionals. I appreciate all of you who tell me when I make a mistake. Donna Cartwright — who is a genuine expert — provided corrections on that UHC policy: “Epifix and Grafix are the only amniotic...
by Caroline Fife, M.D. | Jul 25, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
I appreciate everyone who has emailed and messaged me their questions about the proposed rules for hospital outpatient departments and doctors’ offices! I have invited real experts in coding and reimbursement to provide guest but in the meantime, I will provide the...
by Caroline Fife, M.D. | Jul 23, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
I am noticing how often Nurse Practitioners are being indicted for healthcare fraud. It is partly due to the fact that a very large portion of the CTP/CAMP use is being billed by nurse practitioners. However, it is also due to the nature of the agreements they’ve...
by Caroline Fife, M.D. | Jul 21, 2025 | Hyperbaric Oxygen Therapy
A few days ago, the Department of Justice (DOJ) released information about individual indicted for health care fraud and one interesting case involved hyperbaric oxygen therapy. Yvoune Kara Petrie of Leesburg, Virginia was charged with health care...
by Caroline Fife, M.D. | Jul 17, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
The proposed rule for Hospital Outpatient Prospective Payment System (HOPPS) has been posted. Like all of the proposed payment policies, it’s massive and you need to read it yourself. CMS is proposing to “unbundle” “skin-substitutes” in the hospital outpatient...
by Caroline Fife, M.D. | Jul 15, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
CMS has released the proposed CY 2026 Physician Fee Schedule. CMS is proposing to continue to pay for CTPs that have a biologic license agreement (BLA) using ASP +6%. However, all other products would be paid at $125.38/cm2 (prior to the application of the geographic...
