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Satisfying the MIPS Falls Risk Assessment – Check Out This Article in Today’s Wound Clinic!

Satisfying the MIPS Falls Risk Assessment – Check Out This Article in Today’s Wound Clinic!

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...
Satisfying the MIPS Falls Risk Assessment – Check Out This Article in Today’s Wound Clinic!

Federal Register Correction Notice Explains the Error That Caused CMS to Miscalculate the HBOT Facility Fee

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...
We Need to Talk About the Implications of the “Lymphedema Treatment Act” with Regard to DME Orders

We Need to Talk About the Implications of the “Lymphedema Treatment Act” with Regard to DME Orders

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...
Satisfying the MIPS Falls Risk Assessment – Check Out This Article in Today’s Wound Clinic!

Here are the Specific Questions That CMS is Asking Regarding the Development of the “Non-Pressure Ulcer” Cost Measure

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...
On Feb 1st, CMS Started Testing the “Non Pressure Ulcers Episode-Based Cost Measure.” What the Heck is That, and Why Should You Care?

On Feb 1st, CMS Started Testing the “Non Pressure Ulcers Episode-Based Cost Measure.” What the Heck is That, and Why Should You Care?

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...
Musings By a Soon-to-Be Medicare Beneficiary

Musings By a Soon-to-Be Medicare Beneficiary

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!”...
An Update on the Hyperbaric Oxygen Fee Reduction

An Update on the Hyperbaric Oxygen Fee Reduction

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)....
Palmetto & Hyperbaric Oxygen Therapy Covered Indications – Check out the Links to Failing Flaps

Palmetto & Hyperbaric Oxygen Therapy Covered Indications – Check out the Links to Failing Flaps

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...
Palmetto & Hyperbaric Oxygen Therapy Covered Indications – Check out the Links to Osteomyelitis

Palmetto & Hyperbaric Oxygen Therapy Covered Indications – Check out the Links to Osteomyelitis

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...
Cellular and/or Tissue Based Products Make News – But Not in a Good Way

Cellular and/or Tissue Based Products Make News – But Not in a Good Way

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...
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Recent Articles

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  • Scam Alert! CMS Issues Warning on Medicare Audit Phishing Scheme July 7, 2025
  • Their Lives, Fortunes & Sacred Honor July 4, 2025
  • More Info on the Individuals Indicted by the DOJ Around the Use of “Skin Substitutes” July 1, 2025
  • BREAKING NEWS in the DOJ Press Conference! More Skin Substitute / Cellular Tissue Product (CTP) Fraud Indictments June 30, 2025

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