by Caroline Fife, M.D. | Oct 19, 2021 | Healthcare Payment Policy
I’ve mentioned that am a huge fan of Knicole Manuel. You should check out her latest blog post about Targeted Probe and Educate (TPE) audits. The various Medicare regions were hitting wound care and hyperbaric medicine physicians/hospitals hard with TPEs prior to...
by Caroline Fife, M.D. | Sep 30, 2021 | Healthcare Payment Policy, Tales of the Medicare Disadvantaged
Here’s a new post from our Patient Correspondent, Patricia Han, RN, about Medicare Drug Plans. She’s a retired nurse with many chronic health problems who used to be employed by a payer. I always learn something that a doctor ought to know from her real world examples...
by Caroline Fife, M.D. | Aug 23, 2021 | Healthcare Payment Policy
The Center for Medicare and Medicaid Services (CMS) moves slowly but once they start down a path, they don’t stop (no matter who is the President). In 2008 they started down a path to link Physician payment to patient outcome. It doesn’t seem real yet. If you do...
by Caroline Fife, M.D. | Aug 10, 2021 | Healthcare Payment Policy, Tales of the Medicare Disadvantaged
Why my patient with Medicare Advantage does not have any wound dressings, even though he has had “skilled home health” for 3 weeks. And to make this more fun, my hospital says we are spending too much staff time on each patient so we need to see them faster. This...
by Caroline Fife, M.D. | Jul 21, 2021 | Healthcare Payment Policy
The Centers for Medicare and Medicaid Services (CMS) has just released the proposed rule for Calendar Year (CY) 2022 on the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (APCs). If you are currently working in a hospital-based outpatient...
by Caroline Fife, M.D. | Jun 7, 2021 | Healthcare Payment Policy
Check out my editorial in Today’s Wound Clinic about the way that things have changed for the outpatient wound center. It happened again today — a patient could not afford a huge copay for a compression bandage, thanks to the fine print of his Medicare Advantage...
by Caroline Fife, M.D. | Feb 23, 2021 | Healthcare Payment Policy
You will want to read this – Dick Clark’s presentation to an Administrative Law judge about a Medicare denial for late effects of radiation to the bladder. Teaching an Administrative Law Judge a thing or two about hyperbaric medicine. For more information about...
by Caroline Fife, M.D. | Feb 2, 2021 | Healthcare Payment Policy
Even if your Medicare Administrative Contractor (MAC) is NOT Noridian or WPS, believe me you want to pay attention to their wound care or dressing policies because the MACs tend to collaborate (even unofficially) on these policies. When there’s a mistake in the wound...
by Caroline Fife, M.D. | Jan 22, 2021 | Healthcare Payment Policy
It’s happening more and more often. Patients have such high co-pays and deductibles that the basic things needed for wound management are becoming unaffordable. I am seeing this with private pay insurance and with Medicare Advantage plans (see more about this in...
by Caroline Fife, M.D. | Jan 12, 2021 | Healthcare Payment Policy, Tales of the Medicare Disadvantaged
Here’s another story from Patricia Han about her Medicare “Disadvantage” plan: –Caroline I started looking for a Medicare Advantage (MA) plan in 2013. I studied every plan in detail. As I have mentioned, I am a nurse and have worked in the insurance industry and...
