by Caroline Fife, M.D. | Apr 12, 2024 | Fight the Good Fight, Hyperbaric Oxygen Therapy
As anyone knows who has treated a patient with late effects of radiation to the bladder, the impact of HBO2 can be dramatic in terms of improving life-altering symptoms like radiation cystitis which causes bleeding and pain with urination. Some patients can bleed so...
by Caroline Fife, M.D. | Apr 11, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
I am trying to find ways to visually depict our current situation with regard to Cellular and/or Tissue-based products (CTPs). Several things can be true at once: Package pricing in the hospital-based outpatient department (HOPD) limits the cost per PIECE that a...
by Caroline Fife, M.D. | Apr 9, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight, Healthcare Payment Policy
United Healthcare has updated its Skin and Soft Tissue Substitutes policy effective May 1, 2024, which details the coverage and documentation criteria specifically for EpiFix or Grafix® (GrafixPL, GrafixPRIME and GrafixPL PRIME) (Non-Injectable). The policy also...
by Caroline Fife, M.D. | Mar 25, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
I’ve posted previous blogs detailing what I’ve learned about the impact of establishing the Average Sales Price (ASP) for products, and the perverse impact that an established ASP seems to have. Here’s a visual example of the insanity of pricing and the problem with...
by Caroline Fife, M.D. | Mar 21, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight
Last week I attended the inaugural Cellular, Acellular, and Matrix-like Product (CAMP) Summit. It was a very interesting and well-run meeting. I will digress to mention the acronym “CAMP” which is gaining traction over the more awkward (and possibly obsolete) Cellular...
by Caroline Fife, M.D. | Mar 19, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Fight the Good Fight, Healthcare Payment Policy
Five months ago, I posted a blog about the Centers for Medicare and Medicaid Services (CMS) posting special instructions on how to submit a claim for CTP/skin subs that was $100,000 or more. I was horrified. By way of background, you need to know that one of the...
by Caroline Fife, M.D. | Mar 18, 2024 | Fight the Good Fight
I am thrilled that the topic of lipedema made it on to the AMA educational hub – thanks to an interview with my friend, the amazing Dr. Karen Herbst! That’s amazing exposure for a much ignored problem. Years ago, when I first met Dr. Herbst, she was talking about her...
by Caroline Fife, M.D. | Mar 12, 2024 | Fight the Good Fight
I know this stuff is frustrating and boring, but I really need your help. Below are some specific instructions for looking at your field test report. There are a lot of things I am worried about. So far, I have seen THREE reports. Yes, Medicare is working at a method...
by Caroline Fife, M.D. | Mar 11, 2024 | Fight the Good Fight
I need your help. If you are a wound care practitioner, I need you to follow the instructions on my blog and download your “Non-pressure ulcer” Field Test report and have a look at it. I know that you are already thinking, “blah blah blah” and I don’t blame you....
by Caroline Fife, M.D. | Mar 7, 2024 | Fight the Good Fight, Quality Payment Program
I know there is “MIPS” fatigue and that for most wound care practitioners, the whole Quality Payment Program has felt irrelevant. However, this year, if you are “eligible” to report (that’s Medicare’s term for “you have to do it”) and fail to do anything about it, you...
