by Caroline Fife, M.D. | Jun 1, 2023 | Healthcare Payment Policy
There’s a reason that CMS is talking about “package pricing” of CTPs (aka “skin substitutes”) in the doctor’s office. Proposed policies from CMS do not come out of nowhere. CMS notes changes in the volume of claims and then tackles those changes with policies. The...
by Caroline Fife, M.D. | Apr 14, 2023 | Dr. Helen Gelly, Fight the Good Fight, Healthcare Payment Policy, Hyperbaric Oxygen Therapy
Recently, a clinician inquired about Medicare documentation requirements for hyperbaric oxygen therapy (HBOT). In particular, they wanted to know once a patient has started HBOT, how often the follow up visits with the physician should be performed, and what should be...
by Caroline Fife, M.D. | Mar 24, 2023 | Fight the Good Fight, Healthcare Payment Policy
It’s a poorly kept secret that audits of wound care services rendered under the Medicare fee-for-service payment system are so pervasive that I don’t know anyone who is NOT in an audit of some kind. The entire alphabet soup of auditing bodies are at work: TPE,...
by Caroline Fife, M.D. | Feb 27, 2023 | Healthcare Payment Policy
A few days ago, I got one of those CMS “eblasts” about the results of Medicare CERT audits (Comprehensive Error Rate Testing). The audit looks at whether there is sufficient documentation to back up the claim against Medicare. In 2021, CMS estimated that, based on...
by Caroline Fife, M.D. | Feb 13, 2023 | COVID-19, Healthcare Payment Policy
I got an email from a fantastic wound clinic manager who is worried about the less than stellar documentation she’s noted on the part of her advanced practitioners. She’s trying to raise the bar on wound care documentation and asked me how best to do that. That’s a...
by Caroline Fife, M.D. | Feb 2, 2023 | Healthcare Payment Policy, Quality Payment Program
I suspect that most of the people reading this have at some point in their lives, quietly accomplished something that they know to be important but which will largely go unnoticed. Sometimes we do things just because we have to be at peace with the person who looks...
by Caroline Fife, M.D. | Dec 2, 2022 | Healthcare Payment Policy
Check out this article by Marcia Nusgart in Today’s Wound Clinic: 2023 Medicare Physician Fee Schedule: Wound Care Wins, Challenges, and Opportunities! Caroline Fife, M.D.Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes...
by Caroline Fife, M.D. | Nov 4, 2022 | Cellular / Tissue-Based Products, Healthcare Payment Policy
The Centers for Medicare and Medicaid Services (CMS) has issued the final rule for the 2023 Physician Fee schedule CMS IS NOT finalizing the payment approach outlined in the proposed rule in which they proposed to make Cellular and/or tissue-based products (CPTs) part...
by Caroline Fife, M.D. | Nov 1, 2022 | Healthcare Payment Policy
I just finished a FREE 4 part series with Kathleen Schaum about keeping money after an audit. Here are the top 10 things that Kathleen Schaum listed as the reasons doctors and hospitals lose money when audited (my paraphrase of what she said): Lack of documentation to...
by Caroline Fife, M.D. | Oct 12, 2022 | Healthcare Payment Policy
There’s an astounding increase in every possible type of Medicare audit – one of which is the Recovery Audit Contractor (RAC) audit. It’s a good idea to keep abreast of all the resources available. Check out RACmonitor and its monthly podcast. The site is an online...
