The Voice of Podiatrists

Serving Over 10,000 Podiatrists Daily

November 19, 2007 #3,096 Editor-Barry Block, DPM, JD

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Foot Problems are Not “Normal” – NY Podiatrist

No one should consider foot problems "normal," says Robert Piccora, DPM, a former associate professor at the New York College of Podiatric Medicine and chairman of Podiatry at Gramercy Surgery Center in New York City. "Sure, your feet might feel a little sore after you've been on them more than usual -- maybe you went for a long hike or spent the day shopping," he says. "And you might get a blister if you wear shoes that don't fit perfectly. But if you're in pain -- or if you notice any bumps, bulges or bends in your feet -- you should pay attention."

Dr. Robert Piccora

Some of the most common types of pain come from problems with the toe joints, says Dr. Piccora, and the most common types of these problems are bunions -- caused by misalignment in the junction of the big toe and the foot -- and hammertoes, which are deformities in the second or third toe joints. Unlike more superficial problems, such as blisters and calluses, these conditions are the result of changes in the bony framework in the foot. They look bad, they often feel worse, and they won't go away on their own. "Both bunions and hammertoes tend to run in families," Dr. Piccora says.

PA Podiatrist Arrested on Drug Charges

A Berks County podiatrist was arrested today on charges that he was fraudulently writing and obtaining prescriptions for his personal use. Attorney General Tom Corbett identified the defendant as Stuart F. Deitcher, D.P.M, 46.

Dr. Stuart Deitcher

Corbett said that a hospital employee revealed that Dr. Deitcher was observed to be acting out-of-character and that he moved at a slow pace, appeared to be falling asleep while treating patients and dropped objects repeatedly. Additionally, the grand jury found that Dr. Deitcher had difficulty walking and standing, recognizing staff members, working on residents' toenails, and writing patient notes.

The grand jury found that between 2002 and 2006, Dr. Deitcher received more than 39,500 dosage units of hydrocodone from medical supply companies. There is no record that Dr. Deitcher dispensed the medication to his patients, and the charges allege that the hydrocodone was for his own personal use. Corbett said Dr. Deitcher's medical license was suspended by the State Board of Podiatry on Nov. 22, 2006. Dr. Deitcher is charged with one count each obtaining a controlled substance by misrepresentation or fraud, dispensing or prescribing to a drug dependant person, prescribing outside accepted treatment principles, failure to keep required records, and furnishing fraudulent material information in records required to be kept.

Source: PA Attorney General’s Office [11/15/07]

CMS Reports Continuing Decline in Improper Claims

The CMS said improper Medicare claims declined to 3.9% in 2007 from 4.4% in 2006 and 14.2% in 1996—the result of aggressive oversight efforts involving detailed data analysis in targeting areas where there might be waste, fraud and abuse. During the past three years, error-rate reductions in Medicare fee-for-service have led to approximately $11 billion less in improper payments, the CMS said.

The CMS pays more than 1 billion fee-for-service claims each year. The report, which is released annually in November, was based on detailed reviews of randomly sampled Medicare claims submitted between April 1, 2006 and March 31, 2007. Approximately 140,000 claims were included in the Medicare error-rate testing program.

Source: Cina Becker. Modern Healthcare [11/16/07]

QUERIES (NON-CLINICAL)

Query: Employee Transport of Patients

I accidentally discovered one of my employees has been transporting a few patients home after their appointments. She somehow managed to leave the office during normal business hours without signing out of the office or obtaining permission and driving them to their homes. Fortunately, there has not been any problems. How does one address this problem with both the employee and patients? What are the legal liabilities?

Kimberly Wilkie, DPM, Willow Grove, PA

Editor’s Response: PM News does provide legal advice. There is a concept in law known as respondeat superior, which hold an employer responsible for the action of employee who act “within the scope of employment.” Based on the scenario presented, you would likely be liable in this situation. If you wish to continue this well-intentioned practice, you should check with your business insurance carrier, and determine if this practice falls within your policy coverage.

RE: MRSA Prevention Guidelines (Ronald W. Hines, DPM)
From: Elliot Udell, DPM

In addition to being the excellent doctors, we have to become public educators when it comes to MRSA. It's important to teach patients the important difference between MRSA infection spread and other infections that can also be transmitted from patient to patient. Most people are very unknowledgeable, and the media seems all about scaring the public and creating a public frenzy.

Let’s start by explaining to patients that staph is a normal bacteria on skin and if people cuts themselves and do not take proper care of the wound, they can develop an infection, which in a non-immunocompromised patient will probably be a staph infection. In most cases, common antibiotics such as Keflex and topical antimicrobials can easily treat these infections. In cases where the infections turn out to be methicillin-resistant strains, cultures taken and antibiotic sensitivities done by the labs will reveal other choices of antibiotics. Do assure the public that there are specific antibiotics that can treat MRSA infections and they are generally not the life threatening infections as portrayed in the media.

Lastly, many non-educated people, which are a significant percentage of people, are under the misimpression that MRSA spreads like TB, or influenza, and if someone has this infection he/she is at-risk of catching it if the person coughs or sneezes. I kid you not! Let’s start educating the public that is not the vector or means of transmission.

We also have to take precautions as to not overuse antibiotics and to keep our practices aseptic, so as to reduce the formation and spread of drug-resistant strains of bacteria.

Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Chart Audit (Name Withheld)
From: Multiple Respondents

I also received this notice, but the information was asked for by mail, not an in person audit. This topic was discussed at my last division meeting of the NJPMS, where other DPM's have also been contacted by MedAssurant for chart reviews. It appears that this is for patients who are covered by Horizon Medicare and that Horizon Medicare is being audited by CMS and that is the reason for the chart audits.

Alan L. Bass, DPM,, RPh, Manalapan, NJ, abassdpm@optonline.net

This is a recently developed standard of practice now for the private carriers. Those that deal with the Medicare system in particular are mandated now to do chart reviews. Typically, they will ask in advance for records, come to the office and scan files into a database. This has been nearly pervasive in MA recently.

Because of the contracts we sign, we have no choice but submit to the audit. The Medicare Advantage programs are doing these audits to basically justify their existence and to show that all ICDs have been appropriately captured by the provider.

We have not seen any of these (YET) turn into a bigger fraud type audit. We also have been in discussion with the APMA legal consultants who tell us we must comply with the audits.
I would not hesitate however, to ask them why they want the records and what they are looking for.

Michael King, DPM, Co-chair, APMA Health Systems Committee, mkftdoc@aol.com

MedAssurant is a company hired by other carriers to do their audits for them. You may be able to call MedAssurant and convert the audit to a records request only, instead of subjecting yourself to an office visit from them.

The problem I encountered with them was that their policy was to have multiple audits per year. We were told that no positive result would be reported to us. But after reassuring us that we were ok by the lack of notice, we then received another records request within four months or so of the original. Obviously, one begins to get paranoid. But it was just their policy. The second audit had nothing to do with the first. Med Assurant themselves recommended that I complain to the carrier if I didn't like the policy. I did.The carrier got me off the list and now will limit any requests to no more than once per year. In NY we have a podiatry protection plan under NYSPMA, and I called them for help when I was concerned.

Gregory B. Nellis, DPM Gloversville, NY, gbndpm@yahoo.com

RE: Billing Services (Ray Brown, DPM)
From: Judd Davis, DPM, Carla-Ruth Poma

I would highly recommend against billing services. In my opinion they charge far too much for what they do. Don't let anyone fool you into thinking that billing is rocket science. It is attention to detail and nothing more. Many of the large payers such as United Healthcare, Aetna, etc. have free online claims submission via their websites. Claims can be submitted in under 5 minutes each on some of these sites and you will be paid faster as well. Keeping your billing in house also gives you some amount of control.

In my case, I had a billing service for over a year and was burned repeatedly. This included their failure to submit within the timely filing cutoff, sending claims to the wrong payer/address...This all added up to a nightmare of appeals and resubmissions which is still continuing to this day. Bottom line is: Nobody cares about your claims the way you and your office do. Find someone with billing experience, pay them a competitive rate, keep it in-house, and you will benefit in the long run. If you decide to farm your claims out, watch them like a hawk.

Judd Davis, DPM, Colorado Springs, CO, jtdavisco@yahoo.com

We have been billing for podiatrists for 24 years. We do not have a minimum charge for services. We allow our physicians to decide what services they require from complete billing, posting, follow-up, patient statements and reports to just billing. In-office billing is not for everyone and there is no perfect software for everyone. It has been reported that generally using a billing service can increase revenue by a minimum of 10%. Staffs come and go. Billing services don't get paid unless you collect. Look for a reliable service that you can have a good rapport with.

Carla-Ruth Poma, Michigan Medical Billing Specialists, Inc., Mmbsinc@aol.com

P/T ASSOCIATE POSITION - QUEENS, NY

10 yr old practice seeks motivated, surgically-trained individual . Fax CV with hours available to (718) 458-0053.

ASSOCIATE POSITION NEWPORT BEACH BEVERLY HILLS CA

Do you have a dream of treating movie Stars and the rich and famous? Outstanding opportunity for PSR36 graduate to join Solo practitioner Summer 2008. Must have passion to practice at the highest level of Podiatry all aspects. Partnership in the future a must. Please send resume to Ifabs@earthlink.net

LOOKING FOR ABPS BOARD CERTIFIED/QUALIFIED PODIATRIST - VIRGINIA

Hospital-Based Practice with Tremendous Growth Potential and a Fantastic Opportunity for the Right Doctor. I am looking for someone who will be an associate for a couple of years, then discuss Partnership Buy-In. This practice is currently solo-DPM – but I am turning away patients each day “because doctor is too busy.” Currently, I am in the OR 2 full days a week. Qualified candidate DOES NOT need significant rearfoot experience, but arthroscopy skills appreciated. Need strong surgery and people skills, with emphasis on wound care, forefoot surgery, diabetic problems, etc. No nursing homes. My office is a brand new state-of the-art facility with digital x-rays, computerized EMR, etc. Immediate start available, SALARY commensurate with experience. Please send resume to: podmed@mac.com

ASSOCIATE POSITION - ILLINOIS

Excellent opportunity for ethical & personable hard-working individuals to join a busy multi-office two physician practice. Looking for one podiatrist with interest in conservative care, including sports medicine and one podiatrist trained in rearfoot surgery. Rearfoot surgeon must be board eligible and working toward board certification. Competitive salaries, 401-K, health insurance, paid vacation and more. Please forward CV with references to nrussell@neondsl.com

ASSOCIATE POSITION - WEST COAST, FL

Outstanding opportunity for PSR-36 graduate to join highly successful group podiatry practice in Summer 2008. Seeking a sociable, articulate graduate who is confident in rearfoot and ankle reconstructive cases but also enjoys all phases of podiatry. Long-term opportunity for the right candidate with generous pay and benefits. Reply to jwicks@ips-med.com

ASSOCIATE POSITION- NORTH LOS ANGELES COUNTY

Full scope of podiatry. Requires usual skills in surgery, medicine and biomechanics. Must be self-starter and highly motivated. Two full days per week. May soon increase to three days per week. All billing and administrative aspects handled by staff. Can practice autonomously. footguy1@pacbell.net

PRACTICE FOR SALE - MISSISSIPPI GULF COAST

Near Casino's and beaches. Busy Practice with no HMO's and good insurance coverage. Hospital and Surgical Center privileges available. Call (228) 762-9531 or email me at jwbenus@yahoo.com

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