10/28/2014    Paul Kesselman, DPM

Therapeutic Diabetic Footwear and Orthotists and Prosthetists (Charles Ross, DPM)

First, the long answer to your question with some
background: As a podiatric physician, you are
acting as both the prescribing physician and
possibly also the supplier. In your capacity as
the prescribing physician, you may perform the
local foot exam which is required by the
Therapeutic Shoe LCD.

The supplier must obtain the medical records from
the managing physician, obtain the certification
statement from the MD/DO who specifically is
managing the DM and the prescribing physician's
foot exam must be agreed to, initialed by, etc.
the physician managing the DM. Suppliers must do
their own foot and fitting and dispensing
examinations and comply with all the regulations
of the NSC.

Notice, I did not differentiate between who is the
prescribing physician (it could also be an MD/DO
who is managing the DM) or who the supplier is (it
could be an MD/DO or DPM but it can't be the
physician managing the DM unless in a shortage
area).

Thus the short answer is that no matter who the
supplier is, the rules are the rules. Thus they
are same.

The O&P market has been hit by the same
difficulties as we have. I have been involved in
many discussions with their representative
organizations. The PFA which represents
pedorthists has reported that many of their
members have also abandoned this program.
Pedorthists pretty much sell shoes retail and are
in shoe stores, thus their main source of revenue
is retail and not third party reimbursement.

AOPA which represents orthotists and prosthetists
has reported some abandonment of the program. The
latter also provides patients with high end
prosthetics, which costs tens of thousands of
dollars. They are used to all the paperwork
requirements and most of them won't provide an
item until every "i" and "t" are dotted and
crossed. And indeed many just gamble on whether
they will get caught or not.

They are not going to hold up a dispensing of a
$40K prosthetic because they can't get the MD/DO
managing the DM to provide the required
documentation, when all they required for the $40
prosthesis was a detailed written order (Rx) from
the orthopedist/general or vascular surgeon and
his note. BTW, those folks are used to providing
this material over to the O&P folks.

The issue for all is the absurd requirement for
one MD/DO to attest, co sign or agree with the
examination of the other. You can be sure if that
were a requirement for prosthetics there would
also be the same issues.

The only parallel I see in this whole fiasco is
for and you'll pardon me for bringing this into
play is for VEAD (vacuum assist erection devices).
The prescribing physician needs to be one who is
capable of making the diagnosis, but the supplier
must also have the required documentation from the
physician who is managing the systemic cause. They
are often not one and the same (urology and
internal medicine/endocrinology) come to mind.
Their rates of non payment on audit are also in
the mid to upper 50% range.

In essence, this is a mess and no matter who
supplies the shoes, they are taking a risk.
However, if you understand the paperwork flow
which is required, there is a good bet you will be
paid.

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

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