Alison Goldman
Articles by Alison
Podiatry Wound Care Audits
Routine foot care exclusions, at-risk exception documentation, and debridement coding standards are driving new Medicare audits of…
Responding to a Wound Care ADR From Your MAC
The 45-day deadline, chart elements MAC reviewers check, and submission mechanics for a wound care Additional Documentation Reques…
Extrapolated Overpayments in Wound Care Audits
A single flawed sample can turn a handful of wound care claims into a six-figure Medicare demand. Sample composition is where thes…
Wound Measurement Documentation That Survives Audit
Medicare's LCDs require three separate wound measurements and a documented reassessment when healing stalls. Most audit-failing ch…
Building a Wound Care Compliance Program
Chart auditing cadence, coding review, and remediation records are what turn a self-identified billing error into a correction ins…
Wound Care LCD Compliance Across MAC Jurisdictions
CMS nationalized the skin substitute payment rate for 2026, but coverage still depends on which Medicare Administrative Contractor…
Wound Care Kickback Exposure: Manufacturer Relationships
Rebates, consulting fees, and free skin substitute product tied to referral volume can trigger Anti-Kickback Statute and False Cla…
Wound Care in Skilled Nursing Facilities: Audit Exposure
SNF consolidated billing bundles most wound care into the Part A rate. Facility, practitioner, and Part B billing splits are drawi…
Venous Leg Ulcer Care and Compression-Therapy Documentation
Medicare pays for compression bandages only over a qualifying wound. The same chart entry backs the pump, the graft, and every cla…
Skin Substitute Distributor Arrangements and Enforcement
A $309 million DOJ settlement shows how distributor commissions and pricing spreads on skin substitutes become Anti-Kickback Statu…
Selective Versus Excisional Debridement Documentation
Selective and excisional debridement pay differently and require different proof. What the operative note must show, and why wound…
Selecting a Skin Substitute: Documenting Medical Necessity
How to document product selection, conservative care, and wound measurement so a skin substitute claim holds up under Medicare's 2…
Product Purchase Records in Skin Substitute Audits
UPIC and MAC auditors now compare skin substitute purchase records against billed units. A shortfall between the two is becoming t…
Pressure Ulcer Staging and Billing Accuracy
How pressure injury staging errors and present-on-admission coding gaps translate into HAC payment reductions and audit exposure f…
Physician Supervision in Wound Care Clinics
How incident-to billing rules tie wound care claims to direct or general physician supervision, and why undocumented supervision d…
Mobile Wound Care Practices Under Federal Review
Travel-based wound care models are drawing federal scrutiny over place-of-service coding, patient selection, and visit documentati…
Negative Pressure Wound Therapy Billing Under Audit
How NPWT device documentation, duration-of-use limits, and DME overlap with professional wound care billing become audit findings.
Hyperbaric Oxygen Therapy Audits
CMS covers hyperbaric oxygen therapy for only fifteen conditions, and OIG audits found the majority of sampled claims failed to do…
Diabetic Foot Ulcer Documentation Requirements
Medicare's Local Coverage Determinations specify exact documentation for diabetic foot ulcer care: Wagner grading, vascular assess…
Debridement Frequency and Medical Necessity Challenges
How Medicare frequency checkpoints and documentation standards determine whether a repeat debridement claim survives audit review.
CTP Reimbursement Changes and What They Mean for 2027
CMS moved skin substitute reimbursement to a flat per-square-centimeter rate in 2026. A proposed 2027 rule would extend it to non-…
Debridement Depth Coding: 11042 Through 11047
CPT 11042-11047 pay on the deepest tissue removed, not the deepest visible. What documentation each depth tier needs, and how gaps…
Conservative Care Requirements Before Advanced Therapy
Medicare will not cover a skin substitute graft or hyperbaric oxygen therapy without proof that conservative wound care failed fir…
Cellular and Tissue-Based Product Waste Billing
CMS ended wastage billing for skin substitutes effective January 1, 2026, and UPIC audits already test whether billed graft sizes…
UPIC Audits of Wound Care Practices: What Triggers Them
UPICs select wound care practices through data analysis, not complaints. What the outliers look like, and the compliance check tha…
Skin Substitute FCA Enforcement: The Government's Theories
DOJ's $309M Apex Medical settlement maps three theories driving skin substitute enforcement: pricing spreads, medical necessity, a…
Wound Care Prepayment Review: Documentation That Releases Claims
CMS prepayment review holds wound care claims until the record proves medical necessity. The ADR deadline and what reviewers check…
Physician Office Wound Care Billing: Site-of-Service and Supply Audits
Physician office wound care billing faces two audit vectors: place-of-service mismatches and skin substitute supply-line errors.
Wound Care LCD Compliance: Coverage Criteria by Documentation Element
Medicare LCDs condition wound care coverage on documented conservative care, 30-day progress checks, and a medical necessity narra…
Skin Substitute Audits: Product Selection, Size, and Frequency Findings
How the LCD framework, wastage documentation, and application-count rules drive skin substitute audit findings after CMS's 2026 pa…
Medicare Wound Care Documentation: The Chart That Survives Audit
What Medicare requires in the wound care chart: measurements, photographic evidence, treatment-plan progression, and signature req…
Debridement Coding Audits: Depth, Documentation, and CPT 11042-11047
Medicare auditors compare CPT 11042-11047 excisional debridement claims against the depth documented in the chart to build recoupm…
Feds Seize $2 Million From Pasadena Wound Care Clinic Amid Data-Driven Medicare Fraud Allegations
In a stark reminder of the federal government’s enhanced capability to rapidly freeze the assets of its enforcement targets, the U…
CMS Imposes Nationwide Moratorium on Hospice and Home Health Enrollments: A Major Escalation in the J.D. Vance Task Force Crackdown
The Centers for Medicare & Medicaid Services (CMS) has imposed a six-month nationwide moratorium on new hospice and home health pr…
California Hospice Fraud Crackdown: What it Means for Providers & How to Protect Your Business
California’s hospice fraud crackdown is only the beginning of what CMS and Medi-Cal regulators have claimed will be many more case…
The WISeR Model: A New Era of Prior Authorization and Audit Risks for Wound Care
On January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) officially launched the Wasteful and Inappropriate Service…
OMIG Audit Defense New York: What the 2026 Work Plan Means for Providers
Every year, the New York Office of the Medicaid Inspector General (OMIG) releases its Work Plan outlining enforcement priorities.…
CMS Skin Substitute Reimbursement Limitations Signal Continued Scrutiny of Wound Care Providers in 2026
CMS’s 2026 reimbursement overhaul for skin substitutes signals more than cost control. It marks a sharp rise in audits, enforcemen…
The 2025 Healthcare Fraud Takedown Is a Warning Shot for Wound Care Providers
Wound care is now an enforcement priority. The 2025 fraud takedown targets skin substitute billing, graft utilization, and Medicar…
The Performant Audit Playbook: How to Protect Your Practice from New York’s New Medicaid RAC
For years, New York healthcare providers have navigated the complex oversight of the Office of the Medicaid Inspector General (OMI…