by Caroline Fife, M.D. | Nov 9, 2023 | Fight the Good Fight, Hyperbaric Oxygen Therapy
The Outpatient Prospective Payment System (OPPS) final rule was published a few days ago and buried in a table was the new rate for G0277, the “facility fee” for hyperbaric oxygen therapy (HBOT). The rate for 2024 is $73.64 for a 30-minute segment from the current...
by Caroline Fife, M.D. | Nov 9, 2023 | Fight the Good Fight, Hyperbaric Oxygen Therapy, Medicare Audits
This is part of my series of articles about Useful Information on Medicare Audits. I am posting a series of blogs with information directly from the websites of the various MACs. Anyone can access this and I feel a little silly posting it, but several clinicians have...
by Caroline Fife, M.D. | Nov 6, 2023 | Fight the Good Fight, Medicare Audits
I have been posting information from the MAC websites about audits and required documentation, particularly for HBOT since that’s a huge audit focus. I got an email from a colleague in the Palmetto jurisdiction who for many months has been fighting denials for HBOT in...
by Caroline Fife, M.D. | Nov 1, 2023 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
I have been trying to identify the problems in the CTP/skin sub industry in hopes that doing so could inform specific policy changes. Many weeks ago, the Alliance of Wound Care Stakeholders made five specific recommendations to Centers for Medicare & Medicaid...
by Caroline Fife, M.D. | Oct 31, 2023 | Fight the Good Fight, Medicare Audits
This is part of my series of articles about Useful Information on Medicare Audits. Palmetto is the MAC for: Region J: Alabama, Georgia, Tennessee (Region J) Region M: North Carolina, South Carolina, Virginia, West Virginia (excludes Part B for the counties of...
by Caroline Fife, M.D. | Oct 26, 2023 | Fight the Good Fight
I have been like a dog with a bone trying to get to the bottom of the CTP/Skin substitute quagmire, but I don’t want to lose sight of other important things. A few months ago, I heard Suzanne Molony give a presentation at a conference and I thought, “Everyone should...
by Caroline Fife, M.D. | Oct 17, 2023 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
I previously posted this ad from Linked in which has since been taken down. At the time, I thought it was some kind of joke. However, in the past few weeks, the way in which practitioners can make huge profits off the cost of a product has been explained to me. That...
by Caroline Fife, M.D. | Oct 16, 2023 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
…With a Question About the per CM Sq. Price Variations for Products Check out the entire series here. I am in the Novitas Medicare Jurisdiction and I keep an eye on their Medicare Newsletter. Here are the instructions for submitting claims for CTPs/skin subs...
by Caroline Fife, M.D. | Oct 13, 2023 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
Check out the entire series here. I know this story qualifies as hearsay. I could provide the names of the companies involved, but I can’t afford the legal bills. Since I can’t provide the details, you don’t know whether to believe me, but here goes: A doctor called...
by Caroline Fife, M.D. | Oct 12, 2023 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
Check out the entire series here. In 2015, CMS moved to “package pricing” for CTPs/skin subs in the hospital-based outpatient clinic. When that happened, the cost of the product was incorporated into the charge for the visit, and that caused a sudden and dramatic...
