The Voice of Podiatrists

Serving Over 11,000 Podiatrists Daily

August 29, 2009 #3,635 Publisher-Barry Block, DPM, JD

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Buy Children's Shoes for Fit, Not Size: IN Podiatrist

The back-to-school weeks represent one of the peak times for children's shoe shopping, says Dr. Richard Stanley, a podiatrist with a practice on the Southside. Parents need to keep in mind these tips from Stanley and the American Podiatric Medical Association as they peruse the shoe aisle for the young feet in the family.

Dr. Richard Stanley

Buy for fit, not size: Don't assume that because your child has grown out of one size that he or she needs the next size in the new pair of shoes, Stanley says."The biggest mistake I see people make is buying a size instead of fit," he said, adding that sizing may vary from brand to brand or even within a brand.

So, make sure your child tries on both shoes, and that the shoes fit both feet. If one foot is larger than the other, as is frequently the case, make sure that the shoes fit both feet. If you have to use a shoehorn, it's probably too tight, Stanley said.

Source: Shari Rudavsky, Indianapolis Star [8/27/09]

PA Podiatrist Honored As Des Moines University CPMS Alum of Year

A 1989 graduate of Des Moines University was recently chosen as the College of Podiatric Medicine and Surgery (CPMS) Alum of the Year. In addition to being a professional mentor and giving alumna, Nicki Nigro, DPM, of Allison Park, PA, is a diplomate of the American Board of Podiatric Surgery and fellow of the American College of Foot and Ankle Surgeons.

Dr. Nicki Nigro

"Dr. Nicki Nigro likes to give. She and her colleagues, including husband Jeff, give great care to patients at their five-office practice in western Pennsylvania. She gives to her profession through the Podiatry Foundation of Pittsburgh, which funds continuing medical education and graduate residency education and partners with the American College of Foot and Ankle Surgeons on its annual manuscript contest," said Collin Pehde, DPM, member of CPMS Alumni Association Board of Directors.

Dr. Pehde added, "As a member of the Podiatry Foundation's board, and chair of its scholarship and grants committee, Dr. Nigro also guides the annual distribution of more than $130,000 in scholarships to first- through fourth-year podiatric students from Pennsylvania. In addition, she and Jeff are generous supporters of scholarships for DMU's podiatric medicine students."

CA Podiatrist Acquitted on Trumped Up Drug Charges But Must Start New Life

An Inland, CA podiatrist is trying to rebuild his life after being acquitted in a prescription fraud case that authorities said was nationwide. More than two years ago, Christopher Otiko was accused of ordering prescriptions illegally for his wife, who was arrested earlier in the same case. "It was the worst experience of my life," he said.

Dr. Christopher Otiko

Celeste Otiko, who was divorced from her husband in January, 2007, pleaded guilty to conspiracy to possessing controlled substances with intent to distribute, according to court records. She was sentenced to 20 months in federal prison followed by three years supervised released. Christopher Otiko, who lives in Riverside, said his ex-wife testified against him at trial. The trial began Aug. 10 in North Carolina. On Aug. 20, he was found not guilty on all 28 counts.

The arrests made news across the country leading friends who saw it to call him. Many friends and colleagues stopped communicating with him. Over time, he had to shut down his practice in Moreno Valley and had trouble finding another job. "I had a pretty good social standing in my community," he said. "I went from making quite a nice living to literally living below the poverty line." Now, he's trying to start over with a new career outside of medicine. "I've got to figure out what I'm going to do for the rest of my life," he said.

Source: Sonja Bjelland, The Press-Enterprise [8/26/09]
 

MO Podiatrist Sentenced for Medicare Fraud

Bic Chau Stafford, DPM, a podiatrist practicing in St. Louis, MO, was sentenced to five months in prison for fraudulently billing Medicare and then attempting to cover up the fraud, according to a report in the St. Louis Dispatch.

According to the report, Dr. Stafford billed Medicare for complex procedures when she actually performed routine procedures, such as trimming patients’ nails. After $6,840 in payments was denied, Dr. Stafford created fake medical records and resubmitted the claims.

Dr. Stafford pleaded guilty to charges in April and was sentenced to five months in prison, five months of home detention and a $25,000 fine, according to the report. She also agreed to pay the Medicare program $425,000 as part of a civil settlement.
 
Source: Beckers ASC Review [8/27/09]

Query: C-Arms

I purchased a XiScan model 1000 "C" over 10 years ago. It has really been a workhorse, but it is on the fritz. This model is no longer made and the parts are not easy to find. The newer "C" arms that I use at the other facilities seem to be bulky and do not have as many articulation points. I would appreciate any input from those of you who use C-Arms regularly. Any suggestion on manufacturer and model? I would like it to be able to fit through a standard doorway to a treatment room. Any experience with used vs. new? 
 
Tip Sullivan, DPM, Jackson, MS
 

Query: CERT Audits

I just got a call from someone saying they are from CERT Medicare, doing a "random" audit on charts and one of my nursing home patients just came up. They are asking for chart notes. How do I know they are legit? Is a random CERT audit a big issue? Is it something I should be afraid of, or just send them the notes?

Noah Blumofe, DPM, Santa Monica, CA

Editor’s Note: PM News does not provide legal advice. The CERT (Comprehensive Error Rate Testing) audit has been around for over a decade. It was initially designed to measure the overall FFS (fee for service) error rate for carriers, DMERCs, fiscal intermediaries and quality improvement organizations. Then CMS decided to audit these entities individually for compliance error rates and paid claim error rates.

The CERT audits randomly select thousands of claims a year to check for provider compliance and payment errors. While the audit is not itself designed to detect fraud, it is able to identify billing patterns that could indicate fraudulent behavior. While not as threatening as a RAC (Recovery Audit Contractor) audit, this matter should be taken very seriously, as it could result in your having to pay back money, and could also impact podiatry in general. This means providing any and all supporting documentation for the services rendered, including the initial patient note, any relevant subsequent notes, x-ray and/or lab reports, etc. If you have any question about the acceptability of the chart in question, it is a good idea to consult with a coding expert and/or healthcare attorney. 

Query: Getting Paid for Dispensing Wound Supplies

We have been dispensing wound care supplies for patient home use, and billing private insurance plans using the various "A" HCPCS codes. These insurance carriers are denying the reimbursement of the supplies, saying they are bundled into the in-office procedure allowance, and telling us that the "patient is not responsible."

Is there another way to bill the supplies that we dispense to patients for home use?

S. Pfeiffer, Las Cruces, NM

Response: Check the Place of Service (POS) code that you are using. If it is "office" (POS 11), then that is at least part of the problem. If you are selling the items for home use, then the POS should be "12" - home. This does not sound like an insurer that you participate with which gives you some options.

Many insurers have very limited coverage of DME so I would obtain the patient's signature on an "ABN-like" document, and collect payment that day. The patient needs the product, and they would have to pay if they bought it at a drug store! If the insurer pays, you can then refund their payment. Often the insurance payment is not very good, and may even be lower than your cost.

One other caveat, it is important that your cost be reasonably close to what they would pay at a store - if the patient checks and feels you over-charged them, you will likely lose the patient - which could be far more costly when they tell their friends.

Richard Papperman, MBA, CHBME, Cape May Court House, NJ

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RE: Protocol NaOH Matricectomy
From: Rich Bouche', DPM, Marc S. Greenberg, DPM

One of the best kept secrets for ingrown nails is the use of negative galvanic current for nail matricectomies- a technique that is rarely mentioned when discussing available techniques. This is a technique I have used in an active/athletic patient population for 28 years with predictably excellent results. Typically, negative galvanic current is applied via a thin saber at 10 ma for 41/2-5 minutes for a partial matricectomy. With this procedure, NaOH is formed under the saber effectively destroying the mail matrix where applied.  The area is flushed with 5% acetic acid (vinegar) which limits post-op drainage which usually only lasts for 4-7 days. Negative galvanic current machines and sterilizable surgical probes to hold the sabers can be purchased commercially.

Rich Bouche', DPM, Seattle, WA, spmrtb@verizon.net

I think Dr. Gurvis needs to go to the archives a few days back on this topic and re-read my post and others. I made a comment on phenol and EBM. I never said NaOH lacked EBM to support its use or proper use - only that previous posts seemed to indicate that there lacked a standard for the NaOH procedure for all to follow. I never said phenol was any better or worse than NaOH. Dr. Gurvis made a few constructive comments about his use of NaOH and phenol, but sandwiched between some negative complaints that clearly indicate that he is taking this way too personally. Nobody is beating him over the head with an EBM bible (his words) and nobody attacked him or anyone else. Let's move on.
 
Marc S. Greenberg, DPM, Dayton, OH, tripperdpm@yahoo.com

RE: Income Per Patient
From: John V. Guiliana, DPM, MS

Since I was the one who started this rather healthy debate on Bret Ribotsky's Meet the Masters program, I wish to shed more light on the matter.
 
Benchmarks are merely guideposts. They take into consideration a very broad range of practices and practice parameters. Per Visit Value (PVV) can be directly influenced by some factors that are indeed within a practitioner's control and by some that are rather "uncontrollable" (demographic payer mix, etc). They should not be looked at as "absolutes". If a practitioner's PVV falls below benchmark due to such factors as payer mix or choosing to have purely a palliative practice for example, and he/she is practicing as comprehensively as possible, then so be it. More important in this instance is to monitor the trend of the PVV. If one year the PVV is $65 and the next year's is $58, further scrutiny is necessary.
 
John V. Guiliana, DPM, MS, Hackettstown, NJ, footmds@aol.com

ASSOCIATE POSITION WANTED- METRO NEW YORK AREA

Associate position wanted for full-time or part time. Diverse practice to include general podiatry, as well as surgery. Hospital privileges available. E-mail CV along with cover letter to rrranch7@yahoo.com

ASSOCIATE POSITION - FREDERICK, MD

Well-established and growing 2 office state-of-the-art practice located in medical/professional buildings. EMR, Digital X-ray, Ultrasound, DME provider, etc. Competitive Base Salary plus bonus, malpractice, health insurance, etc. PSR 24 minimum/Board Qualified or Certified with ability and desire to take ER call. If interested, forward CV to DOCSBNB@aol.com

ASSOCIATE POSITION - BOSTON, MA

Associate wanted, Full-time or part-time, for busy long time, well established, and well-rounded practice. Good mix of general podiatry and surgery. Office will generate approximately 100+ surgical cases per year. Must have surgical background, ABPS Qualified minimum needed to obtain hospital privileges. Associate position is open for partnership or purchase. Contact robert.nunberg@comcast.net

ASSOCIATE POSITION - CHICAGO, IL

Hard-working, personable, motivated associate is needed for full or part-time position to work in well established 2-office practice in Chicago and NW suburb. Competitive compensation. New podiatrists are encouraged to apply. Send CV to: anthony.spitz@gmail.com or call 847-971-5926.

ASSOCIATE POSITION - DALLAS/FORT WORTH AREA

Seeking well-trained ABPS board certified/qualified foot surgeon for surgical practice with national foot/hand/orthopedic surgery group. Excellent salary/benefits. E-mail CV and cover letter to: slb99@pdq.net

ASSOCIATE POSITION - NEW JERSEY

Established successful practice in Central New Jersey seeking PT/FT Associate. PSR 24/36. Please forward CV to rpg145@gmail.com or fax 908 753-0199.

NEEDED CHICAGO -- NW IND & BALTIMORE/WASHINGTON, DC PODIATRISTS

Home Physicians, a medical group specializing in house calls is looking to hire podiatrists in Chicago, Northwest Indiana, and Baltimore, MD. 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

ASSOCIATE POSITION - CHICAGO AREA

Join one of the most successful, long-established podiatry practices in the Chicago area, with excellent salary and benefits. We have an immediate opening for a full-time podiatrist in a multi practice location in Chicago. Must have two years of surgical residency. Please e-mail resume to fmassuda@footexperts.com

ASSOCIATE POSITION – NORTH CAROLINA

Very busy practice in Western North Carolina, seeking Full-time Associate with hospital and surgical training. If interested please fax resume to 828-252-2272 or e-mail to mfas828@aol.com

EQIPMENT FOR SALE - ORTHOTIC FABRICATION SYSTEM

Amfit Orthotic Insole Fabrication System with Footfax SL Contact digitizer- For Sale Machine, Laptop, rolling bag, small inventory of shoes, insoles, all cords, parts and hardware Asking $10k.OBO! Please contact Jeff at Jhunt@psbank.net for further information, pictures.

WANTED: PRACTICE TO PURCHASE IN BERGEN COUNTY NJ

DPM interested in purchasing a practice in NNJ. If you are considering selling/retiring/slowing down etc let's talk and come to a mutually beneficial arrangement. Open to all situations/options. Contact: AdvancedFtCare@aol.com for quick deal.

ASSOCIATE POSITION - MARYLAND

Full time, hard-working, happy and personable Foot Surgeon needed for busy and growing practice in Frederick and Hagerstown Maryland. PM&S-36 or more required. We have a well-rounded, high tech practice with all types of pathology encountered in our two offices and in two local hospitals as well as our on-site accredited and certified ASC. Very competitive compensation. Please send your CV to drmichaels@rfainstitute.com

PRACTICE FOR SALE - FLORIDA—CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION - FLORIDA

Busy practice in East Central Florida in search of full-time podiatrist to perform routine foot care in office and nursing home. Competitive salary and full benefits available. Reply to jrdpm@bellsouth.net

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