by Caroline Fife, M.D. | Sep 12, 2024 | Healthcare Payment Policy
Starting Nov. 18, Blue Cross and Blue Shield of Texas (BCBSTX) will no longer pay physicians for outpatient or inpatient consultations when they report those services with Current Procedural Terminology (CPT) codes 99242 – 99245 and 99252 – 99255. According to...
by Caroline Fife, M.D. | Sep 9, 2024 | Healthcare Payment Policy, Medicare Audits
I have been posting warnings about the increase in Medicare audits, especially for CTPs/skin subs and hyperbaric oxygen therapy for many years. Because everyone was being audited, I KNEW that my hospital-based outpatient department (HOPD) was going to be audited. The...
by Caroline Fife, M.D. | Aug 26, 2024 | Fight the Good Fight, Healthcare Payment Policy
Noridian, besides being the Medicare Administrative Contractor (MAC) for Medicare benefits within a specific area of the country, also handles Durable Medical Equipment (DME) benefits for Jurisdiction D. As a DME MAC, Noridian recently issued an “update” on the...
by Caroline Fife, M.D. | May 7, 2024 | Fight the Good Fight, Healthcare Payment Policy, Hyperbaric Oxygen Therapy
CMS recently announced that the Total Per Capita Cost (TPCC) cost measure is now open for comment. CMS (through its contractor, Acumen) is gathering comments on the TPCC measure to determine updates to the measure’s attribution methodology (“attribution” is the...
by Caroline Fife, M.D. | Apr 30, 2024 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Healthcare Payment Policy
On April 25, ALL 8 CMS Medicare Administrative Contractors (MACs) released proposed LCD/LCAs for Skin Substitutes/CTPs for DFUs and VLUs. I have already mentioned the fact that the proposed policy sets a limit of 4 CTP applications per year (although additional...
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...
