The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

November 25, 2009 #3,710 Publisher-Barry Block, DPM, JD

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Supportive Shoes Improve the Mall Shopping Experience: NY Podiatrist

Stressed-out feet can stall a mall trip. One area podiatrist believes the best thing you can do is to give them support. "The proper shoe takes stress off tendons and muscle and ligaments," said Dr. Jason White of the New York State Podiatric Medical Association. "Being overweight adds to foot stress. Your bones and soft tissue are not made to absorb that amount."

Foot functions are controlled by your arch and heel, making a solid shoe critical to foot health. Heel stability depends on the back of your shoe, which should not be flexible. A little arch in your shoe, meanwhile, goes a long way to help keep your foot from collapsing. Wear supportive shoes and change them on a regular basis. Orthotics (insoles) help, too.

Source: Jane Kwiatkowski, The Buffalo News [11/21/09]

ME Podiatrist Anticipates Problems With New Medicaid Billing System

Local healthcare providers who accept Medicaid say they are nervous about a new state billing system in light of significant and lasting problems they've had with changes implemented in 2005. Maine's Department of Health and Human Services is on schedule to switch to a new payment system early next year, five years after instituting a program that caused billing problems for hundreds of providers.

Dr. Daniel Benson

Paula Benson, who handles the books for her husband, Dr. Daniel Benson, an Augusta podiatrist, said she has done everything that DHHS told her to do to sign up for the new system, but she's still worried. "I've called and I leave messages and don't get return calls," said. "I'm so afraid." Benson said she's been trying to activate the new account since Oct. 6 without success. She said she was initally optimistic about the new system reducing her workload. Because of problems with the current system, she's been filing requests for payments on paper. At one point in 2007, the state owed the practice $87,000 for 334 claims dating to 2005.

Benson said shehasattended meetings to learn about the new system and can't understand why it has been so hard to sign up.

Source: Susan M. Cover, Kennebec Journal [11/23/09]

Editor's Note: PM News is proud to present excerpts from Meet the Masters.

Bret Ribotsky:  What would you say to a podiatrist who was treating an ulcer on the bottom of a patient's foot and taking x-rays monthly during a four to five month period of healing? Is this good medicine?

Dr. Marc Brenner

Mark Brenner: From a medicolegal point of view, I do not think you could be faulted for this, but I think that from an insurance reviewer point of view, it's problematic. An auditor will look at this and ask what was your purpose in taking these x-rays. What is your thought process, and do your notes substantiate these x-rays?

Dr. Bryan Markinson

Meet the Masters is broadcast each Tuesday Night at 9 PM (EST). This week's guest is noted Podiatry Management dermatology columnist  Dr. Bryan Markinson. You can register for this event  by clicking here

Query: Adolescent Verruca Treatment

Attached are photos are of a 15 y/o female's progressively worsening plantar verruca. These began two years ago. They are unilateral and painful. There are no lesionson the rest of her body.

Painful Verruca, Not Responsive to Aldara Cream

She has failed three months of daily Aldara 5% cream application. No biopsy has been performed as of yet. What treatment options give her the best chance of eradicating these lesions? 

Chris Seuferling, DPM, Portland, OR

Query: Foot Orthotics and Medicare

Are custom orthotics (L3030x2) covered under Medicare for non-diabetic patients?

Peter Park, DPM, Los Angeles, CA

Response: Custom functional foot orthotic devices (e.g., L3000, L3020, L3030) are not covered by Medicare for non-diabetic patients...or for diabetic patients. Functional foot orthoses, as we know, understand, and use them, are statutorily NOT covered by Medicare. It doesn't matter if the patient has diabetes or not.

The only situation in which such devices can be reimbursed by Medicare is if they are an integral and permanent part of a leg brace/shoe. And in that instance, the orthoses must be billed along with the brace. Almost always, that will be billed by an orthotist- not a podiatrist.

The inserts provided to patients with diabetes under the Medicare Diabetic Therapeutic Shoe Bill are covered as long as the devices, patient, and the qualifying certification, prescription are in order. They are billed using the appropriate A551x code.

If you submit a claim to Medicare using L30xx, it should be rejected. Since you know it is statutorily non-covered, you would append a "GY" modifier. The only reason to submit an L30xx claim to your DMAC is because the patient insists, or you are contracted with the patient's secondary payer. In the former case, or if you are not contracted with the patient's secondary, you can bill the patient directly. If you have a Medicare patient with, for example, plantar fasciitis, and you want to provide or have provided L30xx-type orthotic devices, the patient or their secondary would be responsible for payment, not Medicare.

Rick Horsman, DPM, Olympia, WA

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RE: Metanx and Epidermal Nerve Fiber Density Testing
From: Allen Mark Jacobs, DPM

There has recently been posted discussion on the relationship of folate therapy and the development of cancer, and the appropriateness for IENFD testing. Gong, Holly, and Bracci (Cancer Causes and Control, pp.1-9 article in press) noted an INVERSE relationship between folate intake and pancreatic cancer risk. Picciano, et al. (Nutrition Today Vol 4, (4) 2009 note that increased consumption of folic acid may be associated with DECREASED risk of cancer. DECREASED risk of breast cancer has been demonstrated with folate therapy (Gao, et al., Journal of Human Genetics 54 (7) 2009, DECREASED risk of cervical intraepthelial neoplasia with folate therapy (Piyathilake, et al., Cancer Prevention and Research 2 (7) 2009, and DECREASED risk of colorectal cancer with folic acid supplementation (Samaniego, et al., Nutricion Hospitalaria 24 (4) 2009.

Folic acid dietary supplementation has been in effect, and FDA directed since 1998. Elevated levels of UNMETABOLIZED folic acid may be associated with tumor growth (Sweeny, et al., BMC Public Health, vol 9, 2009 Article number 295). Metanx does NOT provide folic acid; it provides L-methyl folate. The conversion of folic acid to L-methyl folate may not occur in many individuals for a variety of reasons, including polymorphism for cofactors responsible for the conversion of folic acid to its active form, resulting in elevated levels of circulation folic acid, NOT L-methyl folate. As an example, deficiency of MTHFRC677, a not uncommon finding, results in elevation of circulating folic acid levels. METANX, unfairly implicated in recent discussion by Dr. Udell, bypasses this problem by administration of L-methyl folate NOT folic acid. With reference to epidermal nerve fiber density testing, the test is utilized to confirm the presence of small fiber neuropathy when other testing is equivocal, to evaluate the extent of disease, and therefore the candidacy of a patient for therapy, and to evaluate the response to therapy.

Allen Mark Jacobs, DPM, St. Louis, MO, allenthepod@sbcglobal.net

RE: Delay of PECOS Implementation

The Centers for Medicare & Medicaid Services (CMS) will delay, until April 5, 2010, the implementation of Phase 2 of Change Request (CR) 6417 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Claims Processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)) and CR 6421 (Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Supplier Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)). CRs 6417 and 6421 are applicable to Part B claims only.

Editor's note: This item from CMS was submitted by Drs. Paul Kesselman and Bret Ribotsky.

RE: Automated Appointment Reminder Systems (Douglas F. Tumen, DPM)
From: Dan Waldman, DPM, Fay Mushlin

My office has been using TeleVox for about a month now. It seems to be working well. It ties into my scheduler software and can be set up for different types of calls. Staff time is freer to do more now.
 
Dan Waldman, DPM, Asheville, NC, DPMcareer@aol.com

Our practice has been very pleased with the Tel-Tek System (Medi-Call). The program confirms appointments for our two offices, (four doctors). It is extremely user-friendly. We have saved hours of our employees' time manually making the calls that usually go to a
voice mail response.

These saved hours are now used in a much more productive way. The company will show you a demo right on your computer. Our contact names at the company are Jody Sherman 800-291-0206 X204 or Harry Geist at X 205.

Disclosure: I have no financial interest in this company.

Fay Mushlin, Newtown Square, PA, teegee46@gmail.com

RE: Employee Vacation and Personal Days (Charles Morelli, DPM)
From: Joel Lang, DPM

When I was in practice, I had both full and part-time employees. I treated them all proportionally equally. Each employee was entitled to a one week (vacation or sick), leave after one year of employment, two weeks after two years, three weeks after three years and four weeks after four years. They were paid the equivalent of the hours per week that they ordinarily worked.

Every employee was paid hourly, so a week's work varied to some degree, but an averge was easily calculated. They could accumulate leave as they wished and take the time for whatever purpose they wished. If it was not sick leave, I did request the courtesy of advance notice (if possible) so that other employees could fill in. If leave hours were used up, absences or vacations were not paid.
 
Summer and Christmas vacation schedules were fixed and had to coincide with my vacation schedule, but that was announced many months in advance to allow them to schedule it at home. They were paid for the usual legal and government holidays. Everyone seemed happy with the system and I rarely, if ever, got a complaint - nor did I ever experience abuse of the system. It was simple to track and everyone appreciated the equal treatment.
 
Joel Lang, DPM (retired), Cheverly, MD, langfinancial@verizon.net

RE: Healthcare Reform and Our Survival (Arden Smith, DPM)
From: Multiple Respondents

The simple answer to Dr. Smith's questions is: because most of the previous generations of physicians, Medicare and Medicaid patients do not care. Most of the physicians who enjoyed the unscrupulous "years of bill and get paid, no questions asked" are retiring soon, have all student loans paid for (if they ever got a loan), or belong to mega practices that do not feel the crunch of the times, so, they do not care.

Most of Medicare and Medicaid recipients, since they do not pay for their medical bills, do not know about how much it costs for their care, and do not look at their EOB's, also do not care.

Unfortunately, Healthcare Reform will take a "cultural" change in our society for people in the USA to realize that having the best care in the world does not come cheap and that ALL should "chip-in" into the pot and not rely on the backs of the tax payers and the government.

Narmo L. Ortiz, Jr., DPM, Cape Coral, FL, nlortizdpm@embarqmail.com

Editor’s note: Extended-length notes by Drs. Kornfeld and Nolen appear at: http://www.podiatrym.com/letters2.cfm?id=30688&start=1

ASSOCIATE POSITION - PHOENIX, ARIZONA

Part Time/Full Time, ethical and hard working graduate of a PSR 24+/36 Residency to join our growing multi-location practice. Good mix of Surgery/Pediatric/Trauma. Very modern offices with EMR, U/S, Digital X-Ray, ESWT, ABI Testing. Excellent referral base, and a well-trained staff. Base salary, bonus structure, benefits. Current AZ License a Must. Please e-mail CV and references to azpodiatrists@hotmail.com

ASSOCIATE POSITIONS - INDIANA/OHIO

PrimeSource Healthcare is a leading provider of mobile, on-site healthcare services at long-term and skilled nursing facilities. Our exceptional growth has created an immediate need for traveling, independent contractors of podiatry services in Indiana/Ohio. Earn between $175k and $225k per year. E-mail CV to kwright@pshcs.com. Visit us at pshcs.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 - 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

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.

PRACTICE FOR SALE - CENTRAL SOUTH CAROLINA

Practice grossing $400,000 annually based on one full-time doctor with two offices. Surgery is currently about 10-15% but can easily be increased. Medicare makes up 52% of revenues. May be able to take over practice with no money down. Interested parties email to footdocsc@gmail.com

ASSOCIATE POSITION - MINEOLA, NEW YORK

Full-time associate position with future partnership potential available with busy multi-office practices on Long Island. Must be proficient in all phases of podiatry with emphasis on surgery, biomechanics and RFC. Minimum standards include either a three-year PSR, or board qualified/certified status with ABPS. Existing hospital privileges with a NY based facility helpful. Interested doctors are encouraged to e-mail their CV to mets724@gmail.com

ASSOCIATE POSITION - NW IOWA (SIOUX CITY AREA)

Well-established, diverse, growing practice. Excellent referral base. Seeking an ethical, hardworking, motivated, caring podiatrist to fill a full-time position. Multiple hospital affiliations. Generous income with room for growth, leading to partnership for the right candidate. See our community www.siouxlandchamber.com. Fax CV, resume, three references to 712-258-9977.

ASSOCIATE POSITION FULL-TIME - SUBURBS OF CHICAGO

PSR 36 - month-trained podiatrist needed for busy suburban Chicago practice. Office and diagnostic equipment state-of-the-art. Full benefit package included. If interested, please fax your curriculum vitae to 847.352.0270 or email to foot1st@yahoo.com

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

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