Query: Employee Incentive Bonuses for Therapeutic Shoe Program
I have had a diabetic shoe program in my office for years. One of my staff members has been in charge of this program and is well versed on the rules and the paperwork that are necessary to run a successful shoe program. However, our shoe numbers have been down lately and I would like to start a reward program for this employee based on the number of shoes that are dispensed as an incentive to be more productive. Does anyone have suggestions for a bonus system for improving our diabetic shoe program?
Query: DME Re-validation Visit Tips
I am re-validating my Medicare enrollment as a DMEPOS supplier for NGS. As part of the re-validation process, I will receive an unannounced site visit from any one of four agencies to ensure compliance. Are there any tips anyone could provide to ensure compliance? What do I need to have prepared to show an inspector; perhaps have anything displayed, or anything pertinent to verify compliance?
Howard Dinowitz, DPM, Brooklyn, NY
Query: Usual and Customary Rates for DME (2009-2014)
Does anyone know where I can find the usual and customary rates for DME from 2009-2014.
Brent Rubin, DPM, Lakewood Ranch, FL
Query: Dispensing Surgical Shoes
I was wondering how other practices handle the dispensing of surgical shoes and boots for outpatient surgeries. Currently, I have my surgery center dispense the boot at the time of surgery. I would love to be able to take back some of the DME revenue that the ASC gets from my surgeries. Do you dispense the boot prior to surgery? If so, does the patient leave a deposit? Or, do you bring the boot with you and dispense it at the surgery center? If so, what is the place of service for that claim?
Adam Siegel, DPM, Chicago, IL
Query: Diabetic Therapeutic Shoe Bill
I was reading the the article regarding podiatric economics in the February issue of Podiatry Management, when I came across the section regarding diabetic shoes. When did the tide turn around that Paul Kesselman now states most claims "are processed without a hitch and are not subject to pre- or post-payment audits." I had stopped dispensing diabetic shoes due to oppressive audits and wondered what changed.
Dale Feinberg DPM, Yuma, AZ
Query: L3000 WRVU Equivalent
I am currently renegotiating my contract with a large hospital network. I am on a strict WRVU compensation plan. I am not getting any compensation for the custom orthotics that I make and give to my patients because there is no WRVU equivalent for the L3000 code. Is there anyone who is employed by a hospital who is getting compensation for the orthotics they make even though there is technically no WRVU equivalent. If so, can you please explain your compensation model specifically for the orthotics?
Kenneth Stumpf, DPM, Indianapolis, IN
Query: Enrollment Fee for Re-validation Request for DMEPOS
I recently received a revalidation request from Palmetto GBA to re-validate enrollment information with the National Supplier Clearinghouse (NSC) as a supplier of DMEPOS using the Internet-based Pecos system. As a podiatrist who has provided DME products and supplies for many years, I understand I have to re-validate every 3 years. My question is, are physicians (including podiatrists) exempt from having to pay the $553 enrollment fee? In the past, I believe we did not have to pay the enrollment fee, as we were exempt due to the hard work of organizations such as APMA and others. The re-validation request stated that they are using new screening guidelines now.
Thomas G. Werner, DPM, Russellville, AR
Query: DME Signage Problem
My office is located inside a hospital-owned medical building and my office door, like many others, is a solid wooden door with a practice identifier and suite number on it. There are lease prohibitions against adding any type of signage that is “non-standard” to the building. This would include a DME “hours of operation” sign. I had this same problem in my previous office as well, and was never able to resolve it. What has the readership done in this type of building/lease door scenario?
Neil H Hecht, DPM, Tarzana, CA
Query: Medicare Re-Validation Fee
I just re-validated today for my Medicare Fee-For-Service (FFS) Medicare Part B provider number for my practice. I have re-validated for my DME supplier number through Medicare (National Supplier Clearinghouse) and had to pay a fee. Does anyone know whether or not a fee is required for Medicare Part B FFS providers when they re-validate?
Joseph Borreggine, DPM, Charleston, IL
RE: Tips for DME Site Inspections
From: Mark K. Johnson, DPM
We received notification from Palmetto/NSC requesting revalidation of my Medicare supplier number; which by definition requires an unannounced site visit. My practice follows all documentation guidelines. My questions to those familiar with the process: 1. Can the unannounced on-site visit occur BEFORE the fee/revalidation application is submitted to NSC? 2. Is a SEPARATE file of all packing slips for DME shoes, CAM walkers, gauntlets, etc. needed? We have a packing slip copy of any DME items kept in individual patient paper charts. 3. Any pearls concerning the on-site visit?
Mark K. Johnson, DPM, West Plains, MO
Response: The DME inspection is usually a formality to ensure that you are a real site. But it is a mandated inspection as per the current copy of the Medicare Supplier Standards. Your revalidation and/or new application won't be processed until the fee is paid. An inspection usually occurs for new suppliers or those undergoing revalidation, but of course it can occur at any time.
Paul Kesselman, DPM, Woodside, NY
Query: Tricare and DME
Would someone inform me more clearly about the change in Tricare and DME. We have never had a problem dispensing DME such as boots or braces.
Brian Kiel, DPM, Memphis, TN
Query: DMERC Questions
1) We called DMERC and were told to post the hours that our front desk staff is in office, not the hours that the doctor is in. Does that make sense?
2) What is the procedure to change the information in your DMERC file? Does this information have to match your Medicare information - i.e., hours of operation, suite number, etc.?
Debra Weinstock, DPM, Howard Beach, NY
Query: Billing for Custom Orthotics
I've obviously missed something very important here. Since when does MC or DMERC pay for custom orthotics? I know they pay for custom AFOs, but thought they did not pay for foot orthotics.
Larry Aronberg, DPM, Lake Worth, FL
Response: There has been much confusion recently on the subject of Medicare coverage and custom foot orthotics (CFO). To end the confusion, it's quite simple: In over 99% of cases that a CFO is required, Medicare will not cover them. To repeat: CFOs are usually not covered by Medicare. Hence, in just about every case, one should NOT (and I repeat NOT) ever use the KX modifier when billing for CFOs. If it's that simple, then why the confusion?
There is a very ,very narrow margin of cases, where CFOs are covered by Medicare and that is ONLY when:
1) The shoe is an integral part of a brace, that is the shoe is attached to the brace (See Forrest Gump).
2) The orthotic is placed into that shoe which is part of a brace.
3) The supplier who provided the orthotic also provided the brace.
In only the above cases, would there be coverage. By using the KX modifier for CFO (L3000-L3020), you are telling Medicare you met the above 3 stipulations. Since these three almost never happen in a podiatry practice, it would be wise to never think that CFOs are covered by Medicare. To obtain a rejection, use the GY modifier, which will result in a patient responsibility (PR) statement by the DME MAC. For more info on the subject, read your DME MAC LCD on Orthopedic Footwear.
Paul Kesselman, DPM, Woodside, NY
Query: Therapeutic Diabetic Footwear and Orthotists and Prosthetists
I have been following the topic of diabetic shoes for some time and have elected NOT to provide shoes for my patients due to the potential for fraud if MY records do not have the appropriate information-especially the PCP notes with all that they are required to state for compliance. As a result, I have been referring my patients to several local O&P facilities and the patients seem to have no problem obtaining shoes and inserts. Are the orthotists and pedorthists required to obtain the SAME information as we are? Are they exempt or do they have another means of providing footwear for diabetics? If they do not, what is their liability, if any?
Charles F. Ross, DPM, Pittsfield, MA
Editor's Note: Dr. Kesselman's response follows in the next section.
RE: UHC and Orthotics
From: Edward Orman, DPM
We recently received a denial from UHC for orthotics. Prior to taking impressions, we performed our due diligence and received pre-certification. We were told orthotics are a covered benefit and a patient is able to get one pair every 3 years. We billed for two units on 1 line. When we received the EOB, UHC separated the orthotics as one unit each and half for each unit. But they only paid for one unit. Their policy states "L300 can only be billed one unit a day." This is one of the craziest thing I have heard in my 30+ years of practice. A patient with two feet who needs orthotics, UHC will only pay for one orthotic a day and only every 3 years.
I told my office manager to bill the second orthotic on the next day. Has anyone else run into this? Is this a way for UHC to get out of paying for something that they say is a covered benefit? What's next, are they going to allow one orthotic every 3 years?
Query: Unhinged Dropfoot/AFO Brace
Who makes the best/most effective dropfoot/AFO brace? An unhinged type is requested. The patient needs a custom brace due to the increased girth of her calf/lower leg.
Sal Galluzzo, DPM, Clifton Park, NY
Query: Is This Sign Sufficient for DME Purposes?
If an inspector showed up and we were out for whatever reason, do you think this sign would be sufficient?
MON 7-12 PM
TUE 7-12 PM
WED 8-12 PM
THUR 7-12 PM
FRI 7-12 PM
Before 7 AM or after 12 PM by appointment
(if closed during OFFICE HOURS, phones calls forwarded to XXX-XXXX)
(closed federal and religious holidays)
George Jacobson, DPM, Hollywood, FL
Query: DME Reimbursement For Podiatrist Whose Pay is RVU-Based
I work for a multi-disciplinary clinic. My pay is based on RVUs. Because there are no RVUs assigned to things like prescription orthotics, diabetic therapeutic shoes, and other DME items, I do not get reimbursed any more for a patient that I prescribe custom orthotics to than someone I treat the exact same way but do not prescribe orthotics. My clinic makes a great deal of revenue from the orthotics, diabetic shoes, and other DME items that my patients receive, yet I am not reimbursed anything for providing the expertise, prescription, and know-how of getting patients the appropriate device to help them. Furthermore, if follow-up or adjustment is needed for that device, I am the one who has to provide it. Is there a common way that clinics reimburse their providers for bringing in the huge revenue involved with all of these DME items?
Query: Diabetic Shoe Coverage
I just finished speaking with BCBS, Anthem Federal Employee program. I was calling on behalf of my patient. He called his insurance company today to find out about coverage for his shoes. After he pays his deductible, he is covered for A5512, the diabetic liners, but not for the shoes, A5500. So, I called myself and got the same answer. When I asked the person I was speaking to, what he was supposed to put the liners in, she laughed. Has anyone else heard of such madness?
Joan E. Schiller, DPM, Euclid, OH
Query: DME Forms
Where can I obtain the proper forms that DME requires and approves? It seems that there are specific requirements which I understand, but are there specific forms that they would approve if filled out and kept in patients' charts, so when they request documents, they will have forms that cover all their requests and rules?
Stanford Rosen, DPM, Tuscaloosa, AL
Query: DME Scenarios
What are the options concerning custom DME for a Medicare patient, when that patient 1) expires 2) moves residence 3) loses a limb 4) changes his/her mind between receipt of the product and dispensing?
Cosimo Ricciardi, DPM, Fort Walton Beach, FL
Query: Denial of DME Application
I recently sent in my application for participation in the Medicare DME program. I paid, via American Express, the fee of $532, filled out the application (July 2013), and have been waiting for my identification numbers. My office manager called for follow-up recently, and was told that the application (and my file) were closed because (according to a supervisor) of a lack of a response requesting additional information. This additional information request was sent to me as a fax.
I just spoke to a supervisor, and explained that we never received such a fax. She said that unfortunately there is nothing that can be done. So right now, I am out $532, and cannot have my application re-opened. I would have to start again (and pay an additional $532). Does anyone have any suggestions as to how I would get this resolved?
Query: Effect of DME Competitive Bidding on Podiatrists
I would like to know how competitive bidding for DME products in large cities like Miami has affected podiatrists dispensing diabetic shoes, braces, wound products, etc.?
Olga Luepschens, DPM, Sebring, FL
Query: PECOS Revalidation Fee
This issue came up several months ago. We sent in the revalidation forms. Today, we got a call from PECOS saying we owe the $532 and that they didn't process our application. We were initially told that the fee didn't apply to our office. Has anyone else run into this problem? Their employees sometimes are great and get it right, but when they get it wrong, it causes all types of trouble for your practice.
George Jacobson, DPM, Hollywood, FL
Query: Web-Based Billing Systems
We are considering switching from our server-based Medisoft billing program to a web-based billing software program. What experiences have PM News readers had with NueMD, CollaborateMD, or any other web-based billing software systems?
Mark K. Johnson, DPM, West Plains, MO