LCD

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

In 1950, J. Edgar Hoover published the first edition of the FBI’s most wanted list. Since that time, no less than 512 fugitives have been featured. Many surrendered after learning that their mug shots were hanging on every post office wall in the country. In medicine, we have an equally infamous public posting: The Office of Inspector General’s (OIG) work list. In 2017, it turns out that hyperbaric medicine services are "public enemy number one." But please, do not surrender just yet.

By Thomas E. Serena MD, FACS, FACHM, FAPWCA

Fans of folk singer John Prine will recognize the homey lyrics describing his views on organ donation. Sitting at my desk a few weeks ago with John Prine twanging in my headphones, I began to slog through the new Noridan Local Coverage Determination (LCD) on hyperbaric oxygen therapy (HBOT). It should not have come as a surprise that the Centers for Medicare & Medicaid Services (CMS) is planning prepayment review for HBOT services. We have been struggling for months in New Jersey, Michigan and Illinois with preauthorization. What is frightening is that a large number of the denials we have seen are completely nonsensical, bureaucratically driven, and dangerous: a patient with osteoradionecrosis of the jaw, for example, was denied because she didn't have 30 days of standard of care; or perhaps the CMS keyword search engine selected out a proscribed adjective!

By The Alliance of Wound Care Stakeholders

The Alliance of Wound Care Stakeholders submitted formal written comments in response to the First Coast Service Option (FCSO) draft local coverage determination (LCD) for Application of Skin Substitute Grafts for Treatment of Diabetic Foot Ulcers (DFU) and Venous Leg Ulcers (VLU) of Lower Extremities DL36013 - note: this directs you to a CMS landing page where you must accept a license/disclaimer, and once accepted it connects you to the LCD).