08/30/2013    Paul Kesselman, DPM

Diabetic Shoe Dispensing (Neil Hecht, DPM)

I could not agree more with Neil. There are a few
stronger Yiddish words my grandparents taught me,
but I promised never to use them in public.
Despite what the carrier medical directors (CMDs)
have done in an attempt to destroy this program,
it is enlightening to know that even the Medicare
carriers can't agree on how many claims are
audited and how many are either rejected on post
payment audit or is required to be refunded on
post payment audit. A difference from 93 to 97%
is not that statistically different. But one from
93% low side on one study to 33% high side on
another is certainly staggering. If the gov't
wizards can't agree, what are we to think.

The original thread here suggested that keeping a
copy of the date that patient last saw the MD/DO
or have him sign your note with that information
would be adequate. I only wish that were true.

It is mandatory to have a copy of the MD/DO's
record from a face to face encounter with the
patient within 6 months of the date of shoe
delivery. This is the number one issue and one
which cannot be defended in its absence during an
audit.

While I don't agree with its presence by the
policy makers, the interpretation by the CMDs or
the ALJs, it nevertheless is required.
The absence of podiatric notes, orders,
certification statements are usually not true and
are due to a lack of proper diligence on the part
of the auditors.

If your patients truly want to obtain this
benefit, they must be educated (as must the
MD/DO) that they are an integral part of the
process.

As for fears of audits, I'm more concerned about
the absurd regulations and documentations with at
risk foot care. One podiatrist suggested that the
tense of the word debridement could make all the
difference in the world. So if you truly are
fearful of surviving a gov't audit, why not just
stop taking Medicare altogether?

Paul Kesselman, DPM, Woodside, NY,
drkesselmandpm1@hotmail.com

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