02/05/2013    

RESPONSES / COMMENTS (DME) - PART 1B

RE: Diabetic Therapeutic Shoe Bill (David S. Chung, DPM)

From: Mark K. Johnson, DPM

We have been doing the diabetic shoe  program since 2000. While it is not an easy road, it does provide a valuable service to patients who comply with it. Our audits increased to 30% of DM shoe cases last year. Most passed the first round, but, some required resubmission of documents to the next level of redetermination, which has a 40-60 day delay in payment. Our documentation is ethical, extensive, and fully compliant but some reviewers obviously or purposely don't see that. We submit a letter with a timeline and copies of EVERYTHING REQUESTED.

We find Dr. Josh White's Worry Free DME procurement system for the MD/DO documents helpful. You must have a certifying physician office note copy including DM diagnosis and treatment within 6 months of the DME dispense date in documents. A few doctors are sluggish or, rarely, unable to sign the Medicare required forms. So be it. We feel that the program benefits our diabetics who choose to comply with it. We monitor and document that as well. Cautiously optimistic, we accept that certain aspects of podiatry will continue to be challenging, and difficult but not insurmountable in the future. We hope.

Mark K. Johnson, DPM, West Plains, MO. DDR004@centurytel.net

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07/02/2013    

RESPONSES / COMMENTS (DME) - PART 1B

RE: Effect of DME Competitive Bidding on Podiatrists (Olga Luepschens, DPM)

From: Kevin A. Saluck, DPM

In a nutshell, the DMEPOS Competitive Bidding Program will have a dramatic effect on the DME/HME industry but, as of today, I see little to no effect on podiatry. July 1, 2013 starts Round 2 of this program. Round 1 consisted of 9 CBAs and Round 2 consists of 91 CBAs. There are 9 product categories that are affected-CPAP Devices, Respiratory Assist Devices; Enteral Nutrients, Equipment and Supplies; Hospital Beds and Related Accessories; Mail-Order Diabetic Supplies; Negative Pressure Wound Therapy Pumps and Supplies; Oxygen Equipment and Supplies; Standard (Power & Manual) Wheelchairs, Scooters, and Related Accessories; Support Surfaces (Group 2 mattresses and overlays); Walkers and Related Accessories.

 

In Dr. Luepschens’ query, she mentions diabetic shoes, braces, and wound products.  L codes are not included in this program (at this point-CMS reserves the right to add or subtract product categories). She mentions wound products; the only wound care that is currently in this program is NPWT. The only other DME that podiatrists might order are wheelchairs, walkers, and maybe scooters.

 

More information on the DMEPOS Competitive Bidding program can be found at Medicare.gov. Stay tuned as the DME industry and Congress are actively trying to stop or fix this fatally flawed program.

 

Kevin A. Saluck, DPM, Mount Laurel, NJ, drsaluck@comcast.net

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02/09/2013    

RESPONSES / COMMENTS (DME) - PART 1B

RE: Diabetic Therapeutic Shoe Bill (Josh White, DPM, CPed)

From: Dale Feinberg, DPM, CPed

While at the recent Professional Footware Association meeting in Little Rock, Arkansas, I had the opportunity to discuss my difficulties of Medicare audits with Dr. White. I reviewed  his documentation. Just getting the primary care doctor to agree with your extensive note doesn't cut it in Fargo, North Dakota. 

I am not disagreeing that other podiatrists in other regions have less difficulty with the program, but unfortunately these are my experiences as a full-time practitioner who is in the trenches everyday, and not a middleman who is not fiscally responsible for Medicare audits.

Dale Feinberg, DPM, CPed Yuma, AZ, hd5bl@aol.com

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03/01/2012    

RESPONSES / COMMENTS (DME) - PART 1b

RE: Pre-Payment Audits for Therapeutic Shoes (David Dowell, DPM)

From: Greg Karian, CPed

As a DPM, Medicare allows you to make the diagnosis of the qualifying condition (non-DPM providers cannot). When you make the diagnosis, the PCP does not have to examine the patient’s feet. Sending a copy of your diagnosis notes to the PCP is the right first step.  Next, you need to have the PCP initial, date, and indicate agreement with your diagnosis. If you don’t do this, you’re relying on the PCPs to make adequate notes, and all you can do is keep your fingers crossed that they’ll be able to provide those to you when your claim gets audited. You should send this acknowledgement request along with your initial request for the Certifying Statement, and ask them to return both to you at the same time. Dr. Comfort’s “Check 7” system gives you simple instructions for this step of the process, as well as customizable forms you may choose to use (download at drcomfort.com/MedicareHandbook.doc).

Greg Karian, CPed, Manager Customer Service, greg@drcomfort.com