by Caroline Fife, M.D. | Oct 3, 2023 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Featured
Check out the entire series here. Here is another example. Feel free to keep sending me examples and I will redact the names of the company and post. Can anyone tell me why no invoice is needed to submit these claims and exactly how these profits are being realized?...
by Caroline Fife, M.D. | Oct 2, 2023 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
I know there is widespread celebration over the fact that 3 MACs have rescinded their Local Coverage Determinations (LCDs) for CTPs/skin subs. There’s no question that there were a LOT of problems with those LCDs. However, the MACs are attempting to manage bad...
by Caroline Fife, M.D. | Sep 29, 2023 | Fight the Good Fight, Medicare Audits
I’ve been publishing a series of articles about Useful Information on Medicare Audits. First Coast is the MAC for Florida, Puerto Rico, U.S. Virgin Islands. Here’s the checklist First Coast used for a Targeted Probe and Educate (TPE) audit. Checklist looks the...
by Caroline Fife, M.D. | Sep 28, 2023 | Fight the Good Fight
This morning, three Medicare Administrative Contractors (MACs) Novitas, CGS Administrators, and First Coast Service Options, published updates to their local coverage determinations (LCDs) on “Skin Substitute Grafts/Cellular and/or Tissue-Based Products,”...
by Caroline Fife, M.D. | Sep 28, 2023 | Fight the Good Fight, Medicare Audits
Clinicians sometimes email me about Medicare audits that they are undergoing. Since nearly everyone is being audited on either hyperbaric oxygen therapy (HBOT), the use of “skin subs” – properly known as Cellular and/or tissue-based products (CTPs) — or...
by Caroline Fife, M.D. | Sep 14, 2023 | Fight the Good Fight
Twenty years ago, my husband, a busy Ob/Gyn, reached the point that he was not able to pay his malpractice premium (six figures) and his office staff – much less take home any income. One evening we discussed whether he was going to have to quit practicing Obstetrics...
by Caroline Fife, M.D. | Sep 13, 2023 | Fight the Good Fight
Franz Kafka was a Czech-born writer whose fictional stories depict nightmarish settings in which characters are crushed by nonsensical, blind authority. “Kafkaesque” is a term often applied to bizarre administrative situations that can’t be resolved with logical...
by Caroline Fife, M.D. | Sep 12, 2023 | Fight the Good Fight
The 988 National Suicide Prevention Lifeline allows people to get help via phone, text, or online chat for any mental health-related distress. It was launched in 2022, but most Americans don’t yet know it exists. Despite the low level of awareness about this resource,...
by Caroline Fife, M.D. | Sep 6, 2023 | Fight the Good Fight
There is a huge disconnect between “real world” wounds (and the patients who have them) and those studied in clinical trials. This disconnect means that the treatments developed may not work for the patients who need them most, and it is used as an excuse for payers...
by Caroline Fife, M.D. | Sep 5, 2023 | Fight the Good Fight
This blog post is directed at all physicians and allied health professionals involved in hyperbaric oxygen therapy. The goal of this blog post is to explain the changes that CMS is proposing in the Medicare Physician Fee Schedule (MPFS) for the technical payment of...
