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...
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!”...
