CMS has released the CY 2025 Final Rule for the Hospital Outpatient Prospective Payment System...
CMS Releases 2025 Final Rule for the Hospital Outpatient Prospective Payment System (OPPS)
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Wound care updates and original insights
Breaking News! LCDs for Cellular Tissue Products / Skin Substitutes Released!
Read them here (more to come): [pdf-embedder...
Bipartisan Bill Introduced That Would Provide a 4.7% Medicare Physician Payment Update
A bipartisan group in the US House of Representatives introduced a bill that would provide a 4.7%...
FDA Approves Changing the Expiration Date of Some IV Fluids Made by Baxter to Help Alleviate Shortages
In the wake of shortages made worse by Hurricane Helene, the Food and Drug Administration (FDA)...
Check Your Final 2023 MIPS Scores Available Online – Scores Will Impact 2025 Physician Payment!
Check your final MIPS scores for the 2023 performance year, available on the QPP website. Should...
“To Self-Disclose or Not to Self-Disclose”: Check Out Attorney Knicole Emanuel’s Blog
To Self-Disclose or Not to Self-Disclose! | medicaidlaw-nc (medicaidlawnc.com) Healthcare attorney...
Templated Notes and Medicare Audits
A recent blog by Knicole Emanuel discussed the issue of templated notes and Medicare audits....
Loss of Baxter Facility in N.C. from Helene is Affecting Availability of IV Solution and Shortages May Worsen Due to Hurricane Milton
Hospitals are facing shortages of IV fluids following Hurricane Helene’s damage to Baxter...
Reminder: Final Scores for the 2023 Performance Year of Medicare’s Merit-Based Incentive Payment System (MIPS) are Now Available Online and the Deadline to Request a Review is October 11 at 8 PM ET
Check your scores soon as they will impact your 2025 Medicare payment! Should an error be found,...
UnitedHealthcare Launches a “Gold Card” Program in October to (Hopefully) Reduce Prior Authorization Woes
UnitedHealthcare plans to launch a program in October geared toward streamlining prior...
Due to the Impact of Beryl, CMS Has Automatically Applied a Hardship Exemption Within the 2024 Merit-Based Incentive Payment System (MIPS) Performance Period to Eligible cC Areas
Due to the impact of Hurricane Beryl on Texas physician practices, the Centers for Medicare &...
Check Out the New Article in TWC “I’m Getting Audited – Now What?” by Stephen Bittinger
Check out this article, "I'm Getting Audited - Now What?" by attorney Stephen Bittinger, a partner...
Aetna to Cut Payment for Urgent Care Surgical Services and Payments for NPs and PAs
Starting Sept. 1, Aetna will pay 75% of the contracted rate for surgical procedures performed in...
The Average Cyberattack Breach Costs ~$11 Million – and the Number of Attacks Per Week is Increasing
An article in Healthcare Finance News reports that, “The global health care sector experienced a...
In 2025, Physicians Face a 2.8% Pay Cut While Mandatory Participation in an MVP Looms
For the fifth year in a row, the 2025 CMS Medicare Physician Fee Schedule (MPFS) forecasts a...
Does Which EHR a Doctor Uses Impact the “Cost” Category of MIPS?
Someone emailed me a very interesting question about MIPS performance. By way of background, the...
Noridian and CGS Release FAQs on Lymphedema Compression Treatment Items
Noridian and CGS Provider Outreach and Education have released the most frequently asked questions...
Health Information Technology Proposed Rule (HTI-2) is Out
The U.S. Department of Health and Human Services (HHS), through the Office of the National...
Global Internet Outage Continues to Impact Many Healthcare Systems
A global internet outage which began Friday continues to impact many hospitals as well as banking...
2025 Medicare Physician Fee Schedule is Out (and CMS Did Not “Package Price” Cellular Tissue Products / Skin Substitutes in the Doctor’s Office)
The Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2025...
Breaking News! OPPS Proposed Rule is Out!
The Outpatient Prospective Payment System (OPPS) proposed rule has come out! It will take time to...
Accelerated and Advance Payment (AAP) for Medicare Ends on July 12
The Biden administration announced the termination of a program that provided more than $2.55...
CMS Adds 76 New Items to its Master List of DME Supplies That May Be Subject to Prior Authorization (and Some Surgical Dressings are on the List)
The Centers for Medicare & Medicaid Services (CMS) added 76 new items and deleted three from...
How the DEA is Working to Help Communities Get Rid of Unused or Expired Prescription Medications
That drawer or cabinet of old medications can be dangerous. However, it’s hard to know what to do...
How to Subscribe to the NGS Self Service Plus Newsletter
It’s always a good idea to subscribe to the email list serve of your Medicare Administrative...
Physicians Have Until Dec. 31 to File a MIPS Hardship Exemption Due to the Change Cyberattack
Due to the ongoing impact of the Change Healthcare cyberattack on physician practices, the Centers...
Skin Substitute Proposals: What You Can Do
On April 25, 2024 all seven Part B MACs released proposed policies that would govern the...
What Doctors Wish Patients Knew About Prior Authorization
What doctors wish patients knew about prior authorization | American Medical Association...
Pneumatic Compression Devices Are in the Spotlight for 2024 Audits
Check out the article by attorney Knicole Emanuel just posted in Today’s Wound Clinic: Pneumatic...
CMS Explains its 2024 Value-Based Care Strategy
A new CMS blog entitled "Update on the Medicare Value-Based Care Strategy: Alignment, Growth,...
A Little Reprieve for Physician Pay Cuts
A 3.4% Medicare physician pay cut took effect on January 1, 2024. However, thanks to the passage...
MIPS Quality Measure #130 Documentation
MIPS Quality Measure ID #130, “Documentation of Current Medications in the Medical Record” carries...
CMS Announces Flexibilities in the Wake of the Change Cyberattack
Federal officials have announced several flexibilities to help physicians in the wake of the...
CMS Announces Reopening of 2023 MIPS EUC Application in Response to Change Healthcare Cyberattack
I am reposting the entire message from the CMS about the extension of the Extreme and Unavoidable...
CMS Removes the Requirement for AUC From the 2024 Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) has yielded to pressure and removed the...
Update on the Surgical Dressing Policy – Thanks to the Alliance of Wound Care Stakeholders
The Alliance of Wound Care Stakeholders has had another policy win! The Alliance met with the DME...
G2211 Documentation
Last month’s blog explained HCPCS G2211, its appropriate use, and inappropriate use. HCPCS G2211 -...
Resources from CMS and the AMA to Help You Implement Changes to Physician Documentation & Billing
There have been two major changes in the regulations pertaining to physician documentation during...
Medicare Audits on Pneumatic Compression & Surgical Dressings – “It’s About the Documentation…”
I am a huge fan of attorney Knicole Emanuel’s blog and her most recent post is directly relevant...
Be Careful Billing the New CMS G2211 Add-on Code for Visit Complexity
Beginning January 1, 2024, CMS is finalizing the implementation of a separate add-on payment...
Claims Disruptions Continue After Cyberattack on Change Healthcare
Change Healthcare – a healthcare technology company that is part of Optum and owned by...
Ransomeware Cyberattack on Change Healthcare is Affecting Individual Physician Practices Too
United Health-owned Change Healthcare has confirmed the ransomware group “ALPHV/Blackcat” is...
Noridian Has Begun Requesting “Documentation to Support Credentialing of the Provider Performing the HBO Service”
Contact us if you have received this request! This is a guest blog from Dr. Helen Gelly, who is a...
New Coding When Caring For a Complex Condition
HCPCS G2211 - Visit complexity inherent to evaluation and management associated with medical care...
CMS Final Rule on Prior Authorization Released
Prior authorization (PA) is costly, inefficient and responsible for patient care delays. The...
Surgical Dressing Webinar by Noridian on March 7th
On Thursday, Mar 7, 2024 from 12:00 PM - 1:00 PM CST, Noridian is offering a webinar on Surgical...
Noridian Offering Tutorials on Hyperbaric Oxygen Therapy (HBOT)
Noridian is offering two self-paced training tutorials to “assist providers and facilities in...
Novitas Releases Top Ten Reasons for Claims Denials…and Wound Centers Should Especially Check Out Reason #7
Novitas* released a list of the top 10 reasons for claims denials. Reason #7 for claim denials is...
MIPS Revenge!
2023 marked the 5th consecutive year of COVID-related MIPS exceptions that were either...
Noridian is Offering a Feb 13th Webinar on the Lymphedema Compression Benefit Category
On Tuesday, Feb 13, 2024 from 11:00 AM - 12:30 PM CST, Noridian is offering a Webinar for DME...
Pneumatic Compression Devices Webinar by Noridian on Feb 13th, 2024
On Tuesday, Feb 13, 2024 from 2:00 PM - 3:00 PM CST, Noridian is offering a webinar intended for...
The Deadline to Submit MIPS Data for 2023 is April 1 at 6 pm EST to Avoid up to a 9% Penalty on Medicare Revenue
The data submission period for Medicare’s Merit-Based Incentive Payment System (MIPS) 2023...
Time Sensitive! It’s Not Too Late to Sign the Letter to CMS Protesting the 41.5% Reduction of HBOT Facility Fees!
The response to the proposed 41.5% cut in the hospital facility fees for HBOT in 2024 has been...
CPT® Change for 2024
The 2024 CPT® code set1 takes effect January 1, 2024. There are major changes to CPT coding...
Without Warning – the Outpatient Prospective Payment Final Rule Cuts HBOT Facility Fees by 40%
Just so you have the info, it this blog post: Without Warning - the Outpatient Prospective Payment...
ICD-10 Changes
A new ICD-10 Clinical Modification (ICD-10-CM) code set took effect October 1, 2023. In this new...
Modifications Needed to Wound Center EHR to Support DME Orders for Dressings
There’s a lot of conversation about the way in which wound documentation determines whether a...
Mindfulness, Electronic Health Records and Ebola
The Centers for Disease Control (CDC) is warning doctors to watch out for cases of Marburg virus...
JZ Modifier Use With Skin Substitutes
CMS has issued guidance1 requiring the use of Modifier JW on all claims for biologicals from...
Observations About the 2024 PFS Pertaining to Cellular and/or Tissue-Based Products in the Doctor’s Office Setting
On July 13, 2023, CMS issued proposed rules for the 2024 Physician Fee Schedule (PFS) and the...
“Hidden RAC Audits” – Seriously…
Attorney Knicole Emanuel has posted a chilling blog on her site about hidden RAC (Recovery Audit...
Ulcer Debridement & Total Contact Cast Application
We cannot submit CPT®[1] coding for both ulcer debridement and total contact cast application when...
Listen to a Podcast with Dr. Helen Gelly, “How to Get Your Wound Clinic Through an Audit”
On your drive home, check out this podcast with Helen Gelly MD, FUHM, FACCWS, UHM/ABPM, “How to...
HBOT Facility Payments are Under Attack (Physician Supervision is Next…)
This blog post is directed at all physicians and allied health professionals involved in...
Check Out the Long List of CTPs (“Skin Subs”) Not Covered in the CGS, First Coast, & Novitas LCDs
Three Medicare Administrative Contractors (MACs) CGS Medicare, First Coast Service Option (FCSO)...
Highlights of the 2024 Outpatient Prospective Payment System (OPPS)
On July 13, 2023, CMS issued proposed rules for the 2024 Physician Fee Schedule (PFS) and the...
PRESS RELEASE: New Study in Journal of Medical Economics Shows Decrease in Chronic Wound Medicare Costs Amid Increase in Chronic Wound Prevalence
Over 2014-2019, the number of Medicare beneficiaries with chronic wounds increased 13% to 10.5...
New Surgical Treatment of Nails Policy
The Centers for Medicare and Medicaid Services (CMS) has implemented a nationwide policy...
Chiropractors Treating Diabetic Foot Ulcers?
It was bound to happen. Chiropractors have been offering “hyperbaric oxygen” treatments with...
Prior Authorization Nightmares & the Antidote to Burnout
This article just published in the “Intelligencer” resonated with me - "The Two Words That Can...
HIPAA Does NOT Require That Healthcare Providers Obtain Patient Authorization to Disclose Protected Health Information (PHI) to Other Clinicians for Treatment Purposes
Misconceptions about the HIPAA laws can negatively impact patient care and waste hours of staff...
Medicare Extrapolation Under 50% Error Rate? No Extrapolation ALLOWED!
I am a huge fan of attorney Knicole Emanuel’s legal blog, and the latest one is a must-read....
Thoughts on the ICD-10-CM 7th Character in the HOPD
As everyone knows by now, on October 1, 2015, entities covered by the Health Insurance Portability...
The Quality Payment Program and What it Means for the Future of Wound Management & HBOT
The Big Picture of Physician Payment Within CMS The big picture is still playing out for physician...
The Lymphedema Treatment Act Passed!
A staggering percentage of patients with chronic wounds have lymphedema. It’s a disease that every...
Medicare Posts Final Rule for 2024 Policy Changes to Medicare Advantage Plans – Review of Medical Necessity Requirements
Medicare has finalized its 2024 policies for the Medicare Advantage program. I have posted...
New CTP Coding Requirement
Effective July 1, 2023, providers must report the JZ modifier when the entire cellular and/or...
Medicare Posts Final Rule for 2024 Policy Changes to Medicare Advantage Plans
Medicare has finalized its 2024 policies for the Medicare Advantage program. I’ll post a few...
CMS Published 2023 Medicare/caid Health Care Providers’ Audit Process – Read Attorney Knicole Emanuel’s Offer to Clinicians Being Audited
I never miss attorney Knicole Emanuel’s blog posts. I have never met her and have no business or...
New Suture / Staple Removal CPT® Codes
Two new CPT®1 codes for 2023 represent suture / staple removal: CPT 15853: Removal of sutures...
Wound Care Services and the Jimmo Settlement – Why it Matters to Patients Who Are in Palliative Wound Care
Many patients have wounds that simply can’t be healed, and the goal of wound management is to...
Are Verbal Orders Prohibited?
There’s a common belief that The Centers for Medicare & Medicaid Services (CMS) and The Joint...
Give Yourself the Gift of an Audit
Attorney Knicole Emauel’s recent blog post encourages health care businesses to perform a self...
Debunking Myths About Who Can Enter Information Into the Patients’ Medical Record
As you are likely aware, on Jan. 1, 2021, Medicare requirements changed with regard to the billing...
Check Out the AMA Summary of the 2021 Rules for Billing E/M Visits by Time
The American Medical Association (AMA) has released a summary regarding the 2021 changes in...
The AMA Debunks Myths Around Clinical Support Staff Documentation Inside EHRs
There is a myth that clinical support staff such as nurses and medical assistants, are required to...
Expansion of Lymphedema Treatment
On November 1, CMS released the CY 2024 Final Home Health Prospective Payment System Final Rule....
Reminder: 10 Days Until the Close of the 2022 MIPS Data Submission Period
MIPS Eligible Clinicians Can Submit Their 2022 Data through March 31 The Centers for Medicare...
District Court Upholds ALJ’s Decision That Extrapolation Was Conducted in Error
A new post by attorney Knicole Emanual is vitally important for anyone under a Medicare audit....
Check Out This Article by Kathleen Schaum in Today’s Wound Clinic
Check out this article by Kathleen Schaum in Today’s Wound Clinic: Are You Prepared to Implement...
Pandemic Emergency Declarations Scheduled to End May 11, 2023 – Check Out These CMS Resources
From Centers for Medicare & Medicaid Services (CMS): Public Health Emergency Resource Update...
More Exciting E&M Changes!
The process by which office and other outpatient evaluation and management (E&M) levels (CPT®...
Join the Fight with the Alliance of Wound Care Stakeholders
Are you feeling frustrated and helpless in the face of overwhelming regulatory burdens, capricious...
Consolidation of E&M Services in 2023
Effective January 1, 2023[1], under the guidance of the AMA CPT Editorial Panel, many evaluation...
Check Out This Post: The Ugly Truth about Medicare Provider Appeals
Once again attorney Knicole Emanuel has posted a chilling blog about Medicare provider appeals....
Documentation Requirements for Wound Care Services – Part 3
Many Medicare Administrative Contractors (MACs) have policies currently in place that govern...
Documentation Requirements for Wound Care Services – Part 2
Many Medicare Administrative Contractors (MACs) have policies currently in place that govern...
Documentation Requirements for Wound Care Services – Part 1
Many Medicare Administrative Contractors (MACs) have policies currently in place that govern...
CMS and CTPs (Cellular Tissue Products)
Medicare’s traditional “fee for service” (FFS) program is administered through several private...
Place of Service for “Observation” Status Patients
When it comes to coding are “Observation” patients inpatients? No. Medicare considers observation...
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