09/26/2023
QUERIES (DME)
Query: Reimbursement for Custom Orthotics
What do people get paid for custom orthotics? I charge $400 for a pair of custom orthotics. I have done so for the past 35 years. Insurance in my state reimburses me $69.97 per orthotic. Essentially, I'm getting less than $140 to make, evaluate, dispense, and possibly adjust the product... all for a profit of about $30. I am curious as to what others get paid. I have always heard that orthotics are profitable for practitioners in other states, but never for me - unless it's paid in cash.
Orthotics are one of the mainstays of our practice as podiatrists. I feel obligated to provide a service to my patients, even though I received little benefit in terms of reimbursement. It is very difficult to recommend a custom orthotic device when I can simply dispense an over-the-counter product that usually does work well and is much more cost-effective. Don't get me wrong, custom orthotics are an integral part of my practice, just like surgery which also does not pay well. We are all surgeons and that is what we love to do.
Alan Mauser, DPM, Louisville, KY
05/30/2023
QUERIES (DME)
Query: How are NPs and PAs Involved in Diabetic Shoe Documentation
When it comes to diabetic shoes, I would like to have a better understanding of how NPs or PAs are now involved with the documentation process. Can someone elaborate?
Edmond F Mertzenich, DPM, Rockford, IL
08/22/2022
QUERIES (DME)
Query: Apos Shoe Therapy
Does anyone have any information on Apos shoe therapy? I found a post from Dr. Kesselman from 2014 but nothing mentioned in PM News recently. Some primary care providers in my practice have received a number of requests from physical therapists asking for approval for the therapy to treat knee, hip, and back pain. Montefiore Medical Center in the Bronx, NY has a page on their website dedicated to it. My concern is the ability of the physical therapist to properly evaluate the biomechanics involved in the diagnosis and proper use of the devices as well as all of Dr. Kesselman's concerns 8 year ago concerning crossover with orthotic treatment. Apparently, now it is covered by some insurance plans.
Craig Herman, DPM, Jamaica, NY
04/27/2022
QUERIES (DME)
Query: DME Signage Requirements
I am moving my office to a different suite (but same address) in a multi-office medical building and want to be sure that the engraving on the front door of my office is correct with what is required for DME. I looked on CMS.gov under special payment rules for items furnished by DMPECOS suppliers and issuance of DMEPOS supplier billing privileges. It seems like all that is required on my front door is to post the hours the office is open. Is there a way to confirm this is all I need before it permanently goes on the door? Please advise.
MIchelle McCarroll, DPM, Allentown, PA
12/10/2021
QUERIES (DME)
Query: DME Denials
Our office is being inundated with CMS DME denials from Performant and Celerian, going back to 2018. These are for shoes, night splints, and AFOs. All of our "i"s are dotted and "t"s crossed...and we have appealed multiple times, correctly! We know that these appeals are not being looked at because they say we don't have the information that is clearly included in the documentation. We are strongly considering not offering DME for CMS anymore. What other choices do we have...my congressperson?
Name Withheld
08/27/2021
QUERIES (DME)
Query: How to Get Credit for DME Dispensing
I am a podiatrist employed by a large medical group. They are not allowing me to get any credit for dispensing of DME, stating it is a Stark law violation. Every time I bring it up at contract negotiation, they cite the Stark law violation; so I need something that I can bring to the next meeting.
Name Withheld
06/01/2021
QUERIES (DME)
Query: DMEPOS Braces and Medicare
On 5/25/21, CMS issued CR 12282, indicating that beginning 10/1/21, in approximately 17 states, no one other than a licensed prosthetist/orthotist can provide custom and pre-fabricated orthoses. To clarify, does this mean podiatrists could no longer provide Richie braces or Arizona braces to their Medicare patients? What about night splints? This is devastating news, if I am not mistaken. Please clarify.
Neil Levin, DPM, Sycamore, IL
05/14/2021
QUERIES (DME)
Query: Supply Chain Issues With Therapeutic Shoes
This week’s Medicare Council meeting has suggested there are supply chain issues with products associated with therapeutic shoes. Has anyone had such issues with respect to inventory or increased costs?
Paul Kesselman, DPM, Woodside, NY
04/30/2021
QUERIES (DME)
Query: Shoes for Diabetic Amputee
I have a diabetic patient with a BKA. He has a Medicare managed care plan. The family has found a shoe dispenser who accepts his insurance. According to the family, the dispenser wants an Rx from me for a pair of shoes. It sounds weird to me. Is this the usual practice to prescribe a pair of shoes for a patient with one foot?
Ron Werter, DPM, NY, NY
08/27/2020
QUERIES (DME)
Query: Checking for Same or Similar DME
Does anyone know the Medicare site where a doctor can check to see if a DME was dispensed to the patient in the last five years?
Edward Cohen, DPM, Gulfport, MS
07/27/2020
QUERIES (DME)
Query: Source for Arizona AFOs
Does anyone know of a lab that makes an AFO like the Arizona AFO besides AZafo?
Brian Kiel, DPM, Memphis, TN
05/15/2019
QUERIES (DME)
Query: Website for Checking Same or Similar DME
What is the site where we can see if the patient has had a same or similar DME under Medicare? Searching doesn't seem to find it.
Ron Werter, DPM, NY, NY
Response: Each of the Medicare Administrative Contractors (as per CMS requirements) has a provider portal. Both portals have some learning curve to navigate. Signing up for the Noridian Portal is easier (but still somewhat of a challenge) and can be accomplished in under an hour. You can be up and running on the same date or within a few days of application submission. My CGS takes longer, due to the fact that it takes some time for CGS to respond to the applicant with a "token number" which is required to compete their application. Once the token number is plugged into a started application, your ability to use the My CGS portal is...
Editor's note: Dr. Kesselman's extended-length response can be read here.
04/17/2019
QUERIES (DME)
Query: Lapse in DMERC Certification Due to Inactivity
I have been a participating doctor in the DMERC program through Palmetto for many years. I have had no issues with them, and never submitted many claims. I paid my multi-year re-application fee in January of 2018. Today, I received a notice stating I have "not billed out within the past four consecutive quarters" and I have been, effective immediately, de-activated from my billing privileges! Naturally, I must accept responsibility for perhaps not knowing this nuance, BUT....really! Now I must go through the whole process of submitting the CMS 855s form again in its entirety, which has always been characteristically a real joy to do. Is this common? Has this de-activation from CMS been out there and do many not know of this requirement?
Name Withheld
04/25/2018
QUERIES (DME)
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?
Name Withheld
02/09/2018
QUERIES (DME)
Query: DME Inspection
I am scheduled for an on-site DME inspection and would like to know just what will be checked. Thanks for your help.
Name Withheld
09/04/2017
QUERIES (DME)
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
07/22/2017
QUERIES (DME)
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
10/26/2016
QUERIES (DME)
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
02/19/2016
QUERIES (DME)
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
09/01/2015
QUERIES (DME)
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
01/24/2015
QUERIES (DME)
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
01/21/2015
QUERIES (DME)
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
01/19/2015
QUERIES (DME)
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
01/17/2015
QUERIES (DME)
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
01/07/2015
QUERIES (DME)
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
