Wound Care: Medicare Audits & The Skin Substitute Surge

Published: Wed, 08/13/25

Updated: Wed, 08/13/25

Link to all things medical coding & billing

Wound Care: Medicare Audits & The Skin Substitute Surge

Federal contractors – Recovery Audit Contractors (RACs) and Unified Program Integrity Contractors (UPICs) – have increasingly targeted wound care claims, particularly involving expensive skin substitutes billed under Medicare Part B. In 2023 alone, over $1.6 billion was spent on these products, prompting heightened audit activity from Qlarant...

Understanding the 2025 Telemedicine E&M Codes

The American Medical Association (AMA) introduced 17 new telemedicine evaluation and management (E&M) codes this year. Here’s the breakdown of these new codes: CPT® code range 98000-98007 are reported for synchronous audio-video encounters, and CPT code range 98008-98015 are reported for synchronous audio-only encounters...

5 Jobs AI Will Practically Own By 2026

The robots aren’t coming. They’re already here. Last week, I had a chat with my accountant, a 45-year veteran who said his son's job just got replaced by ChatGPT. I won’t name the firm in London. Not downsized. Not restructured. Replaced. While everyone’s debating whether AI will take over the world, it’s quietly taking over paychecks. Goldman...

CMS Proposes Elimination of Inpatient-Only List

The Centers for Medicare & Medicaid Services (CMS) issued its Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule for the 2026 fiscal year this week, and in doing so said that the Inpatient-Only List (IPO) should be phased out over the course of the next three years. The move will reportedly begin with the...

DRG Downgrades by Commercial Payers: Documentation Defense Tactics

In the current climate of cost containment, commercial payers are increasingly downgrading MS-DRGs after claims are submitted, not disputing the need for inpatient care, but questioning the clinical support for CCs (complications or comorbidities) and MCCs (major complications or comorbidities). These downgrades reduce reimbursement, often occur...

The Devil’s in the Diagnosis Details

I think it is important to challenge one portion of an article that was widely distributed two weeks ago. The article included a statement that, while accurately characterizing the way that Medicare Administrative Contractors (MACs) conduct audits, is still demonstrably incorrect. The article asserts that “the old auditor’s adage for incident-to services remains...

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