by Caroline Fife, M.D. | Jul 17, 2026 | Medicare Audits
I have gotten quite a few emails and calls from readers (and their attorneys) about audits focused on skin subs and debridements. Many practitioners simply do not have sufficient documentation to defend the denied claims and honestly, there’s...
by Caroline Fife, M.D. | Jun 23, 2026 | Healthcare Payment Policy, Medicare Audits, US Wound Registry
Medicare payment rates have fallen about 33% since 2001 as inflation continues to rise. Physician payment is the only aspect of US healthcare payment policy that is not tied to inflation. Physicians are closing their doors because they can’t afford to stay in...
by Caroline Fife, M.D. | Mar 17, 2026 | Fight the Good Fight, Medicare Audits
The final MIPS reporting deadline for the 2025 performance year is March 31, 2026. In other words, you have until the last day of March to report MIPS data – that is, if you are required to report. The purpose of this article is to explain the unnecessarily...
by Caroline Fife, M.D. | Feb 20, 2026 | Healthcare Payment Policy, Medicare Audits
By Caroline Fife and Lindsay Horst We’ve been asking you to download your Field Test report for the “non-pressure ulcer” Cost Measure. This issue is important because in the future, CMS can claw back Medicare dollars from a wound care practitioner based on their...
by Caroline Fife, M.D. | Jul 7, 2025 | Medicare Audits
CMS says scammers are sending Medicare providers and suppliers phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit. This notice was posted on the CMS website: “CMS has identified a fraud scheme targeting...
by Caroline Fife, M.D. | Mar 24, 2025 | Medicare Audits
Here’s a guest blog from Michael Crouch, following up on Martha Kelso’s post about audit requirements. I hope the information from these industry experts will help practitioners prepare themselves better for the audits that are bound to happen. If you have been...
by Caroline Fife, M.D. | Mar 18, 2025 | Cellular / Tissue-Based Products, CTP / Skin Substitutes, Medicare Audits
Here’s a guest blog from Martha Kelso, Chief Regulatory Officer at Wound Care Plus, LLC, providing a heads-up about the documentation demands for her most recent audit of CTPs/CAMPs/skin substitutes – this time a UPIC audit. According to the Medicare Program Integrity...
by Caroline Fife, M.D. | Feb 26, 2025 | Medicare Audits
Here’s another fantastic post from attorney Knicole Emanuel about the serious overreach problems inside the alphabet soup of Medicare audits. This is an issue that will get even more problematic due to the delay of the “skin substitute” LCD(s). Some auditors are...
by Caroline Fife, M.D. | Feb 11, 2025 | Fight the Good Fight, Healthcare Payment Policy, Medicare Audits
The Alliance of Wound Care Stakeholders is hosting a webinar on Wednesday, February 12, 2025, 1:00 PM – 2:00 PM EST. If you and your organization provide wound care to Medicare beneficiaries, are you prepared for the important policy updates for 2025 implemented by...
by Caroline Fife, M.D. | Dec 9, 2024 | Fight the Good Fight, Medicare Audits
Attorney Knicole Emanuel has published another fascinating blog! Check out her discussion about the Recovery Audit Contractor (RAC) and the False Claims Act (FCA). Many practitioners are undergoing the full alphabet soup of Medicare audits (TPE, UPIC, SMERC, RAC,...
