Tonia Silva CPC, CPMA, CPPM

11/15/2025

Great article, thank you Dr Lehrman for making this a bit easier to understand.

On October 31, 2025, CMS released its “CY 2026 Medicare Physician Fee Schedule Final Rule.”1 This Rule finalized a new payment model for skin substitute products applied to Medicare Part B beneficiaries during a covered application procedure in a non-facility setting and in the hospital outpatie...

11/14/2025

Stay tuned as more information becomes available on regulatory updates like the following, including this new info on the payment structure in the CMS physician fee schedule for skin substitutes.
https://tinyurl.com/595rsvec

11/14/2025

https://telehealth.org/blog/senate-passes-cr-extending-medicare-telehealth-flexibilities-through-january-2026/?fbclid=IwY2xjawOEEA5leHRuA2FlbQIxMQBzcnRjBmFwcF9pZAwzNTA2ODU1MzE3MjgAAR4ELaEcCxxbdQYzc6xKqf_1PWL4zbJKbYErSlQc8UhabLnqlwaT6s-hLC9pdg_aem_zfomDcZWcv9DzQU5oGn6Jg

The Senate approved a continuing resolution on November 10, 2025, that would extend key Medicare telehealth flexibilities through January 30, 2026.

11/01/2025

2026 Medicare Physician Payment Rule Finalized:
✅Increase in Medicare Physician Payment for 2026
✅Increase in Value for Both Great Toe Arthrodesis CPT Codes
✅New Skin Substitute Payment Policy Finalized
APMA will review the over 2,000-page rule and provide more information! Read more at www.apma.org/MPFSfinalrule.

10/28/2025

If you dispense DME get ready for some take backs on claims for patients that were in a SNF.

A new HHS-OIG audit found that improperly paid suppliers $22.7 million for durable medical equipment, prosthetics, orthotics, and supplies during inpatient stays from 2018–2024. Medicare policy requires these items be provided by the inpatient facility or through its arrangements—not billed separately by suppliers.

In addition, suppliers may have incorrectly collected up to $5.9 million in deductible and coinsurance amounts from enrollees.

We have recommended CMS direct Medicare contractors to recover improper payments from suppliers and ensure suppliers refund enrollees for deductibles and coinsurance. Additionally, CMS should refine its system edits to prevent future errors.

Read the full report here: https://direc.to/fQDj

10/20/2025

The WISeR Model Provider/Supplier Guide is now available. Still no template for the forms, nor a detailed data-element list, nor a portal as of today.

10/11/2025

Pneumatic compression coverage criteria

Medicare covers pneumatic compression devices (PCD) for home use when treating lymphedema or chronic venous insufficiency but only after a physician-supervised trial of conservative therapy has failed to improve the condition. This trial must include compression garments, limb elevation, and exercise for at least four weeks (lymphedema) or six months (venous ulcers) before coverage is approved. Check out our PCD website page for more information.
JA: https://bit.ly/42qEHe1
JD: https://bit.ly/3N9QyJ9

10/11/2025

Watch out for these scams! There is another that comes around in the mail to renew your corporation.

DON'T FALL FOR IT!

I got a call from a DSA member today asking if she should remove PHI before faxing progress notes “to CMS.” Our members know to check with us before sending any patient records to anyone (including those sketchy Part C requests), so I asked three questions: what are you sending, why, and who asked for it?
She read me the fax: “mandatory CMS audit—send records or face penalties or jail.” That’s the same scam notice we’ve been seeing, and the kind CMS has warned about on its fraud page.

Bottom line: if you’re told to fax PHI or call 709 or 647 area codes about a claim—don’t. Those are Canadian numbers, and CMS and its contractors don’t initiate audits by fax or demand PHI that way.

What to do instead
Stop—don’t fax anything.
Verify through official channels (your MAC portal/contractor website or the number you already use—not the one on the fax).
Call me/DSA and we’ll confirm in minutes.

Report the scam to your MAC and keep a copy for your compliance file.
Keep your patients’ PHI protected and your clinic out of a mess.
(903) 343-2454

09/21/2025

Join us for this webinar to receive a better understanding of reading your remittance advice. We will discuss an overview of the remittance advice, explain field locations, view remittance advices in the Noridian Medicare Portal and talk about full remittances.
Registration: https://bit.ly/4mDOh8t

09/21/2025

Register Today! Wound Care Business Navigator Rapid Fire Webinars are a series of microburst learning sessions built to fit into a busy professional’s schedule. Faculty will present practical, targeted tips and insights ready for implementation in your practice. Join us for this free monthly event with audience Q&A, and register for this, or several of our upcoming sessions.
https://tinyurl.com/3uu2te8m

09/21/2025

Interesting that no target group is listed but it seems that medical providers are being targeted when they didn't set these prices. Here's an idea, have audits performed by peers instead of 3rd party groups of RNs that get paid for each denial!

Medicare Part B spending for skin substitutes skyrocketed in recent years, raising interest in what could be driving this trend. HHS-OIG’s new report analyzed Part B, Medicare Advantage, and manufacturers’ sales data for these products to learn more. We identified several concerning aspects of the Part B spending trends and the factors that influence them. Learn more: https://direc.to/fpTC