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 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 6, 2024 | Fight the Good Fight, Healthcare Payment Policy
Satisfying the MIPS Falls Risk Assessment Requirements | Today’s Wound Clinic (hmpgloballearningnetwork.com) More and more wound care practitioners are paying attention to the requirements of the Quality Payment Program (QPP), now that ignoring participation can...
by Caroline Fife, M.D. | Feb 8, 2024 | Fight the Good Fight, Healthcare Payment Policy
CMS has published an Outpatient Payment System (OPPS) correction notice in the Federal Register which contains additional information about the data error that led to CMS to arrive at an inaccurate cost for the hyperbaric oxygen therapy (HBOT) hospital facility fee...
by Caroline Fife, M.D. | Feb 6, 2024 | Healthcare Payment Policy
Like most folks, I am thrilled that patients with lymphedema might have access to much needed supplies like compression bandages, stockings and garments, thanks to the Lymphedema Treatment Act! However, whenever a new “benefit” is added by Medicare, it invariably has...
by Caroline Fife, M.D. | Feb 5, 2024 | Fight the Good Fight, Healthcare Payment Policy
I know there are people out there who eat, sleep, and breathe Excel spreadsheets of clinical codes. God bless you if you are one of those people! That means we need you to comment on the design of the cost measure for “non-pressure ulcers.” I’ve provided the links to...
by Caroline Fife, M.D. | Feb 1, 2024 | Fight the Good Fight, Healthcare Payment Policy
Cost Measures in the Quality Payment Program (QPP) As I have discussed before, CMS thinks that I practice family medicine. Since nearly half the patients with chronic non-healing wounds have heart failure, CMS thinks that I am their primary care doctor (PCP) because I...
by Caroline Fife, M.D. | Jan 25, 2024 | Fight the Good Fight, Healthcare Payment Policy
There’s no way to hide the awful fact that I will be 65 in March. I might as well admit it here since apparently, every insurance company and retailer know it – based on the quantity of junk mail that fills my mailbox with “CONGRATULATIONS ON YOUR 65TH BIRTHDAY!”...
by Caroline Fife, M.D. | Dec 15, 2023 | Fight the Good Fight, Healthcare Payment Policy, Hyperbaric Oxygen Therapy
Guest Post by John Peters, Undersea & Hyperbaric Medical Society (UHMS) Executive Director Caroline, Thank you for allowing me the opportunity to provide an update on the 2024 Final Rule and rate for APC 5061 / Code G0277 (hyperbaric oxygen per 30-minute segment)....
by Caroline Fife, M.D. | Nov 7, 2023 | Healthcare Payment Policy, Hyperbaric Oxygen Therapy, Medicare Audits
I have been posting information from the MAC websites about audits and required documentation, particularly for HBOT. The Palmetto MAC website has detailed information about certain specific HBOT indications if you sufficiently medicated to manage the intense...
