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...
by Caroline Fife, M.D. | Nov 3, 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 a lot of detailed information about certain specific HBOT indications. The website is “cute” – you hover over the...
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...
