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...
by Caroline Fife, M.D. | Jul 14, 2025 | Pressure Cooker: Rethinking Pressure Ulcers
In the August 28, 2024 Final Rule (CMS‑3401‑F), CMS (the Centers for Medicare and Medicaid) updated the list of “Hospital Harms” in the Hospital Inpatient Quality Reporting (IQR) requirements. The new rule became effective this year. I will skip the...
by Caroline Fife, M.D. | Jul 11, 2025 | Hyperbaric Oxygen Therapy
(Photo: HavasuNews.com) Just before 11 am yesterday morning (July 10th, 2025), emergency crews responded to a 911 call about a fatal hyperbaric chamber fire at a facility in Havasu City, AZ. There is very little information available at this time, other than the fact...
by Caroline Fife, M.D. | Jul 11, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes
Summary of the WISeR (Wasteful and Inappropriate Service Reduction) Model for Medicare (The summary below is partially excerpted from a more detailed review by Julie Rhodovi) Federal Register CMS Page and CMMI Page Model Original Medicare’s fee-for-service payment...
by Caroline Fife, M.D. | Jul 9, 2025 | Fight the Good Fight, Healthcare Payment Policy
CMS has released Quality Payment Program (QPP) performance data for 2023. Under the QPP, payment “adjustments” (bonuses and penalties) occur two years after the “performance year,” so that 2023 scores impact a practitioner’s 2025 Medicare payments. It’s important to...
by Caroline Fife, M.D. | Jul 7, 2025 | Medicare Audits
CMS says scammers are sending Medicare providers and suppliers phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit. This notice was posted on the CMS website: “CMS has identified a fraud scheme targeting...
