The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 02, 2008 #3,313 Editor-Barry Block, DPM, JD

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Symptomless Foot Most Likely to be Problematic: ME Podiatrist

Peripheral neuropathy, which affects the feet, legs, and, less commonly, the hands, is dangerous because its symptoms can be so subtle. In fact, the "symptomless" foot is most likely to have a problem. "Pain is what takes most people to the doctor's office," says John B. Perry, D.P.M., a podiatrist in Portland, ME, who specializes in diabetic foot care. "If it doesn't hurt, you don't come in.

Dr. John Perry

The problem is, people with diabetes don't have the same sensations in their feet. You have to check and have them checked when they don't hurt."I tell people with neuropathy that the nerves in their feet aren't sending information anymore," he says, "and that they have to use their brain and their eyes and their fingers to save their feet."

The damage and the danger from diabetic peripheral neuropathy comes from two basic problems: loss of nerve function and loss of blood supply. Both are caused by the primary dysfunction of diabetes: too much glucose in the blood.

Source: Wayne Clark, Diabetes Self Management

Concierge Practice Means Higher Quality of Foot Care: CA Podiatrist

Dr. Ivar E. Roth has cultivated a successful private practice by keeping his focus on what's most important: offering his patients exemplary care that's specifically designed for their lifestyles and issues."More often than not, patients don't have foot problems that cannot be resolved," observes Dr. Roth. "They just have to find the specialist who can do it."

Dr. Ivar Roth

His method involves attentive consultative appointments, and what he describes as a "concierge" level of care that includes open communication with patients as well as colleagues. "In my 23 years in Orange County, I have developed a private practice based upon physician and patient referrals," explains Dr. Roth. His practice is focused on providing the utmost in high-quality, personalized care. The office model is unique; Dr. Roth does not take payment from insurance companies but instead arranges financial compensation from his patients. This, he believes holds him to exceptionally high standards.

"It's the true test of being at the proverbial 'top of your game,'" he offers. "I've got to do a great job of meeting and exceeding my patients' expectations because they can always go to an office that will accept their insurance." (He notes that his office will file insurance paperwork for patients, but that the provider's compensation is remitted directly to the patient.)

Source: Lalaena Gonzalez-Figueroa, M.D. News [August 2008]

Hospitals, Docs Criticize Broader No-Pay Policy

Hospitals and physicians are criticizing the CMS for increasing the number of conditions for which Medicare will no longer reimburse when its policy for not paying for certain conditions goes into effect. It’s questionable whether the conditions are preventable and how they are to be recorded as present-on-admission is unclear, said Beth Feldpush, senior associate director for policy at the American Hospital Association. “We did not agree with any of the conditions” when they were proposed earlier this year, she said.

The original reimbursement policy included eight conditions. The three additional conditions are: surgical-site infections following certain orthopedic and bariatric surgeries; certain manifestations of poor control of blood sugar levels; and deep-vein thrombosis or pulmonary embolism following total knee and hip replacements. But many of those conditions in the policy are not backed up by solid evidence as being completely preventable, according to J. James Rohack, a physician who is president-elect of the American Medical Association.

Source: Jean DerGurahian, Modern Healthcare [8/1/08]

5-Minute Test For Meetings

Before you call a meeting, give it the 5-minute test to find out if you’re ready to meet. Ask yourself:

• Can I state, in a sentence or less, the meeting’s purpose?
• Do I know what things I expect the meeting to accomplish
• Do I know who must be there to ensure that we accomplish those things?
• Could I accomplish the same things with a memo or a phone call?

Additional Tip: Don’t schedule a meeting and then design an agenda. Instead, decide what results you want and design an agenda that will produce those results.

Source: A. Pontish Yeramyan, writing in Successful Meetings

Query: Non-Covered Routine Care

When I treat a Medicare patient for non-covered routine care, do I still need to bill Medicare and obtain a denial before collecting cash from the patient?

If so, why should I have to bill Medicare for non-covered services? If I do have to bill, how do we code it so that they recognize the service to be non-covered? Do I bill, for example, a CPT 11055 or a CPT 11719 without a modifier?

If I do bill the patient for non-covered routine foot care, am I to bill the patient only what Medicare normally allows for these services, or do I have the liberty to charge my usual and customary fees?

Robert Lee, DPM, Los Angeles, CA

Response: If the routine foot care is non-covered (does not qualify for coverage), you do not have to bill Medicare UNLESS either the patient insists you submit the claim or you are contracted with the patient's secondary insurance company.

If you are requested to submit the claim, you would append a "GY" modifier to the routine foot care code to indicate that the service is statutorily non-covered. Essentially, you are expecting and want a denial from Medicare.

Statutorily non-covered services, procedures, or items have no Medicare fee schedule allowance. You would bill your usual and customary fees.

Harry Goldsmith, DPM, Cerritos, CA

Codingline subscription information can be found here

RE: Formula 3 Anti-Fungal (Marcie Struck, DPM)
From: Rick Burnell, DPM

I have been using Formula 3 for about one year now. I find that it works better than Penlac, has better compliance as it does not have to be filed off. It is not going to cure most fungal toenails and I tell my patients this when they get it. I file the nail down and have them start using it. It will usually lessen the amount of fungal debris and help keep the nail thinner. Most of my patients that have used it have been satisfied. Of course, it all depends on compliance.

Rick Burnell, DPM, Camden, SC, burnell_cfc@bellsouth.net

RE: Planter Warts
From: Michael M. Rosenblatt, DPM

.

Dr. Elliot Udell reported recently that tomatoes can "suffer" from Pseudomonas infections. I'm not "red" with envy. Since plants can get virus infections, such infections should be called: "Planter warts."

.

Michael M. Rosenblatt, DPM, San Jose, CA

ASSOCIATE POSITION OPPORTUNITY IN MULTI SPECIALITY GROUP PRACTICE - ILLINOIS

Christie Clinic is a large Multi-Specialty Group practice located in Champaign, Illinois. We are seeking a PSR-36 ABPS Board Certified or Board Eligible podiatrist to join a well established Podiatry department. Must be competent in all phases of podiatric care, Surgical and Conservative. This position will involve rotating through multiple office locations with surgical privileges available at two medical centers and two outpatient surgery centers. Very competitive salary, bonus plan, vacation, and health/mp insurances. Forward CV to wpierce@chrisiteclinic.com

PODIATRISTS NEEDED - CHICAGO --NORTHWEST INDIANA

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists. We are located in Chicago and Northwest Indiana. Full and part time positions are available. Competitive Compensation including malpractice. Contact Scott Schneider. Phone-773-342-4201 FAX 773-486-3548-E-Mail sschneider@homephysicians.com Visit our website

UNIQUE OPPORTUNITY FOR THE RIGHT PERSON! - NEW YORK

We’re in search of a motivated, well-trained DPM who is great with patients. Our well-established multi-doctor, multi-office practice is located in the Hudson Valley region of New York State. All DPM´s in our group are board-certified and there is a residency program affiliated with our practice. Please reply to HVFA, PO Box 3300, Kingston, NY 12402-3300; or via email to bud@hvfa.com

ASSOCIATE POSITION - SOUTHERN CALIFORNIA

Multi-office group seeks associate in Southern California for general podiatry in office setting. NO nursing homes! Spanish speaking a plus. Full or part-time. Excellent compensation with potential for partnership. E-mail scpodgroup@yahoo.com for more details.

PRACTICE FOR SALE MN: PRIME LAKES AREA

Great place to live and raise a family. 400+K yearly gross with continued growth and potential. Good mix of general podiatry and surgery. Hospital privileges available. Fully computerized, electronic notes with capability to go completely paperless. Recently remodeled office, 5 tx/procedure rooms, well-equipped in owner occupied building (for sale or lease). 260 402-7490.

ASSOCIATE POSITION – CALIFORNIA

Coast to Coast Mobile Podiatry Group Seeks Podiatrist with Nursing Home contracts! Join our group and let us handle the back-breaking task of billing and managing your patients. This will equal great compensation for you. Please email us back at coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION WITH OPPORTUNITY FOR PARTNERSHIP

Group practice located on NY-PA border with excellent growth in the area’s industrial, retail, and college campuses. Surgical privileges in medical centers in NY and PA. This position will involve rotating through multiple office locations, and wound care centers. Local insurance reimbursement involves mostly private pay PPO models. We are looking for an ABPS Board Qualified podiatrist to join our team. Candidates would need to obtain licenses in NY and PA, and become ABPS certified to maintain hospital privileges. Base salary starting at $85,000 plus bonus plan incentive, vacation, and health/mp insurances. Forward CV to prefprovider@hotmail.com

PODIATRIST POSITION – SOUTHERN CA

Medical group in Southern CA seeking a residency trained DPM. Practice includes general podiatry, biomechanics, wound care, surgery, diabetic feet, trauma. Part-time position available may lead to full-time. Excellent salary/benefits. Position available in mid July 2008. Please reply to E-mail: slowed2@yahoo.com; 4476 Tweedy Blvd, South Gate, CA 90280

SEEKING ASSOCIATE POSITION - NEW YORK OR CONNECTICUT

PSR-24 trained podiatrist seeking an associate position in New York (Westchester, Putnam or Dutchess County) or Connecticut. Excellent surgical and patient skills. Ethical and hardworking with 3 years of private practice experience. Please contact samalsal@yahoo.com

ASSOCIATE POSITIONS – MARYLAND

Are you motivated, personable and enjoy working with the elderly? We are offering full or part-time positions in Maryland. Our group, Podiatry Management Services, provides care to the elderly in Nursing Homes, Assisted Living, Senior Homes, Adult Daycare and other similar facilities. Please e-mail your c.v. to drhprosen@comcast.net , fax to 410-486-2049, call Dr. Herbert Rosen 410-580-0255

ASSOCIATE POSITION – GEORGIA

Atlanta area need a full-time or part-time associate for a 25 years old well-established practice, well-rounded surgery and routine, please email your CV to superrang@bellsouth.net

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