Medicare's new AI experiment sparks alarm among doctors, lawmakers

[Silent Type]

29. There is a new policy on skin substitutes that removes the incentive for doctors making thousands of dollars off

the 6-month float in pricing, a several billion dollar ripoff of highest proportions.

If your doc uses proper diagnoses codes, it won’t be a problem in your case. And even if it were denied pending additional info, your doc will send in supporting documentation, measurements, skin product, many send photos of wounds especially for exceptionally long treatment. It will be approved within hours.

Now, if you have wounds that don’t heal, or at least show signs of improvement/stabilization, that go on for years, doc will likely have to send in records.

Again, the new coverage policy where doc doesn’t get paid $5000 for a skin substitute that cost him/her $800, will eliminate 90% of claims even reviewed. Wouldn’t be surprised if those edits aren’t removed or restricted to certain diagnoses that exhibit strange utilization patterns.