It is a sad fact that many podiatrists and
orthotists, as well as pedorthists, have
discontinued providing shoes through Medicare.
It has become more difficult to obtain the
required documentation and even when it is
obtained, the auditors often ignore
or misinterpret the documentation that is sent.
In most cases, if the provider bothers to take
these claims up the appeal ladder, they are paid.
As Dr. White has pointed out, there are
formulas for reducing the time expenditure
required of you and/or your staff. One key point
not to forget, it is essential to develop
effective communication with your patients and
those physicians who manage their diabetes. You
must be able to effectively communicate that
appropriate shoes and inserts play an extremely
important role in preventing ulceration,
infection and limb loss. Simply sending the
physician managing the diabetes your request to
fill out some forms you obtained from a shoe
vendor or as listed in the Medicare DME LCD are
not effective.
Most "diabetic foot examinations" performed by
podiatrists don't meet the requirements as noted
in the DME MAC LCD, nor the new face to face
requirements, as mandated by the Affordable Care
Act.
Many MDs are leery at participating as a result
of some articles in publications read by
endocrinologists, suggesting they be
more "picky" at participating simply to line
the pockets of the prescribing or dispensing
entity. Most PCPs and endocrinologists are also
bogged down in endless streams of paper work as
well.
Using effective educational tools for both the
patient and communicating these to the MD who is
managing the DM are likely to
get more attention and generate a positive
response. These also comply with the new "face
to face" regulations required by the DME MAC's
prior to ordering DME.
I have found that no matter what you are trying
to explain to patients (or other practitioners),
show and tell, something we all did in
Kindergarten, is likely to generate the required
response. Educational tools which are largely
illustrative and accompanied by a consultation
note are essential components to a good diabetic
foot examination. Some of these tools include
Pressure Stat and Tempstat. These are
commercially available from Visual Foot Care
Technology (VFT) as part of their "Comprehensive
Diabetic Foot Examination."
As for the fee you pay for DME enrollment, I
would be hard pressed to suggest one
discontinues to pay the $500+ triennial
enrollment fee. Seems like paying $500 or so
every three years and giving up reimbursement on
items such as Cam Boots, ankle braces, surgical
dressings, crutches, canes, afo's, shoes etc, is
not a wise business decision.
Lastly, the number one audited code in podiatry
remains those associated with routine foot care.
The message should not be that the only
effective tool to avoid audits is to stop
providing basic podiatric care. The appropriate
message is to carefully and correctly document
everything you do!
Disclaimer: Dr. Kesselman is a stockholder in
VFT.
Paul Kesselman, DPM, drkesselmandpm1@hotmail.com
