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06/15/2018    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Unreasonable Chart Review


From: Bryan C. Markinson, DPM, Ron Freireich, DPM


 


I am stunned at the naïveté of any of my colleagues who are reassured that the SOLE purpose of these audits are to obtain additional diagnoses to obtain evidence of a more severe level of illness in a covered population so that the insurers can get more money to cover the population. The prosecutors have UNLIMITED power and if any of these "innocent" audits suggest a trend of impropriety as an in incidental finding, start loosening your collar!


 


Bryan C. Markinson, DPM, NY, NY


 


What a crime! I have noticed over the last several years that chart notes from many medical doctors, especially ones that are employed by a hospital system, contain a laundry list of diagnoses. Many of these diagnoses are not active, and in fact may have been from years ago. If one were to actually read the note, the doctor is not managing every one of those conditions.


 


So our reimbursements keep going down and the insurance companies keep making more money “managing” more medically complex patients when they may not be as complex as they report to the primary insurance company. It sounds like the insurance company doing the audits needs to be audited themselves.  


 


Ron Freireich, DPM  Cleveland, OH

Other messages in this thread:


12/01/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Douglas Smith, DPM 


 


On GoodRx.com, generic Penlac runs as low as $17 at Costco. In situations like this, I tell my patients to decline their insurance and use the GoodRx card, app, or website. It's not worth your time to go through a pre-approval process for a cheap generic medication. You'd come out ahead if you actually bought the medication for the patient at that price. 


 


Douglas Smith, DPM,  Raleigh, NC

11/30/2020    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: EHRs, Insurance Carriers, and Prior Authorization


From: Jeffrey Kass, DPM


 


There are numerous times when E-prescribing that I am told that I need pre-authorization for medications. Oftentimes, this can be for ciclopirox - the generic version of Penlac. My EHR invariably is not able to handle the prior authorization and the office has to call in for it. The doctor is mandated to use the EHR. If one chooses not to, they get penalized by Medicare. These systems cost doctors money. Why doesn’t the government force the insurance companies to be compatible and up-to-date with the doctors' EHRs? 


 


I opine if we can’t get an electronic response from the insurance company, then they shouldn’t be allowed to require a prior authorization in the first place. Furthermore, prior authorization on generic medications should not be allowed unless someone can give a logical explanation as to why it’s needed. 


 


Jeffrey Kass, DPM, Forest Hills, NY 

11/24/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From Ron Werter DPM


 


There is no “best” machine. It depends on what you plan on doing with it, but the hand-held models have too small a screen to be useful for our diagnostic purposes. That being said, if you feel you have a knack for diagnostic imaging and love the intricacies of ultrasound, then look at the 20/20 units which are pricey but amazing. If you just want a very basic unit that you can do most imaging (but not as detailed as the 20/20) and for guided injections, then look at something cheaper like the Mindray DC-30 machine.  


 


I also recommend that you purchase a new machine. 


 


Ron Werter, DPM, NY, NY

11/23/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Daniel Chaskin, DPM


 


Dr. Kass brings up a good point. The process is even more questionable for those who hold lifetime certificates. If one holds a lifetime certificate, then every ten years they have to "complete the self-assessment exam". This is the exam Dr. Kass  explained costs $725, and it doesn't matter what you score. So even if you are technically "incompetent", no one would know. If that is the case - other than charging $725, what is the point of it all? The self-assessment should allow the test questions incorrectly answered to be made available for review, so diplomates can study and improve any areas of weakness.


 


Daniel Chaskin, DPM, Ridgewood, NY

11/20/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: James Stavosky, DPM, Nicole DeLauro, DPM


 


The ABPM Maintenance of Certification (MOC) is an ongoing learning process that is a required and critical component of maintaining ABPM board certification. The MOC is intended to strengthen a Diplomate’s practice and ultimately improve patient safety and clinical outcomes. This can be instilled by ensuring current licensing, maintaining continuing education credits on an annual basis, and demonstrating cognitive expertise in the specialty of podiatric medicine. There is data which correlates MOC with improved patient outcomes, higher physician compensation, and fewer disciplinary actions.


 


ABPM MOC pathways are on par with those of our osteopathic and allopathic medicine colleagues and their maintenance of certification processes. Time-limited Diplomates who were certified prior to 2011, who have not already enrolled into the MOC process, must re-credential and take a competency assessment exam prior to enrolling into the MOC process.


 


More information regarding the importance, value, and benefits of the MOC program, can be seen in this recently published article on the Board’s website. For any additional questions related to the MOC, please contact ABPM Headquarters.


 


James Stavosky, DPM, ABPM Executive Director, and Nicole DeLauro, DPM, ABPM MOC, chairperson.

11/19/2020    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: ABPM MOC is a “Crock”


From: Jeffrey Kass, DPM


 


The topic of board certification comes up often in PM News. The latest scam in podiatry appears to be “MOC” or maintenance of certification. Ten years ago, when I was up for recertification, I had to send in case documentation of a certain amount and certain variety of cases. Reviewers checked the logs and cases to ensure proper thought process in making clinical decisions, etc. It was a pain in the neck to do but it made sense. That process was junked.


 


Now, ten years later, I am up for recertification. This time, I was told I had to pay a fee of something like 725 dollars and take a “self-competency exam” of 100 multiple choice questions. It makes no difference what your score is on this exam. You simply take it, when your done you get a notice “congratulations, you...


 


Editor's note: Dr. Kass' extended-length letter can be read here.

11/17/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Jack Ressler, DPM


 


I assume a failed chart audit could mean two things; one being an excuse not to pay your chart fee which I seriously doubt they would pay anyways. The other failed chart audit probably means Ciox couldn’t find anything more to over-bill Medicare for. Podiatrists are totally being harassed by these Medicare Advantage care audits. We as a group should stand together and not be intimidated by these companies. I got a call from PICA a couple of weeks ago pertaining to a query I submitted to PM News about being harassed. Dr. Taubman, the President and Chief Medical Officerof PICA wanted to reach out to me concerning this problem.


 


He had a representative call me. She said they are getting several calls weekly from podiatrists asking for advice concerning these audits. She told me that they are monitoring this situation. They probably cannot do anything about it, but we as a profession do have their support.


 


Jack Ressler, DPM, Delray Beach, FL

11/17/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Stephen J. Bennett, DPM


 



I have long used gentian violet in my office but would not prescribe/recommend it to patients because of its tendency to jump out of the bottle and stain some items of clothing or even furniture. Instead, I have used Lotrimin solution or Oxistat, or a short course of oral antifungals.


 


Did anybody know that gentian violet has been listed as a potential cancer causing agent? In Canada, it is now unavailable and in California, one must declare its risks before use (proposition 65), but it is still available OTC in NYC. I have since modified my office protocol.


 



Stephen J. Bennett, DPM, NY, NY

11/16/2020    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Fear from Ciox Audits


From: John Moglia, DPM


 


I just heard from a Ciox Aetna rep that 3 charts out of 30 "failed" the chart audit. I was informed that Ciox does not pay for a failed chart review. Has anyone else had this experience? What are potential consequences? My position is regardless of pass/fail, the fee for chart retrieval stands with no refund, as the service was provided. My fear is that Aetna will now ask for return of insurance payment for office visits if informed by Ciox.


 


John Moglia, DPM, Berkeley Hts., NJ

11/10/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Dennis Shavelson DPM 


 


For about 8 months now, I have been involved as a professional associate with a company that has been proactive in preparing for the time when doctors' offices can take and get paid for both COVID-19 antibody and antigen testing. This company has worked with institutions and countries to supply tests for years and years. Their clients are fully prepared, licensed, and certified to offer these tests, seamlessly now that the FDA granted an emergency use authorization (EUA) in October. My place in the organization is to mentor and service those who qualify to test but are not familiar about the how, what, when, and why of this matter to get on board this important and profitable train.


 


Currently, the only test DPMs, MDs, and DOs (depending on state law) can perform is the 15 minute rapid antibody finger stick test (no antigen test yet but coming). It is taking about two weeks to become certified and to organize practice(s) to see if it can maintain FDA- and CLIA-compliance. This is working well in urban areas due to the high demand for antibody testing (not reimbursable) but my suggestion is to get involved on this level early, especially if you are having difficulty re-opening during COVID-19 because it will place you on the tarmac for the antigen EUA that will happen so that many more will take advantage of it.


 


Disclaimer: I am a consultant in this industry and have a profit motive.


 


Dennis Shavelson, DPM, NY, NY

11/10/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1



From: Jack Ressler, DPM


 


We use Square in our office. This system is user-friendly with options for connectivity to a smart phone, I-pad, or separate desktop touch pad. It provides instant notification of transactions via emails, and their website provides in-depth accounting. I cannot attest to their fees but I’m sure they are competitive.


 


Jack Ressler, DPM, Delray Beach, FL

11/09/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Jack Ressler, DPM


 


Sending charts to Ciox or the other companies is a big inconvenience, no matter the price you ask. Dr. Moglia, you should reconsider raising your price. At $10/chart, Ciox might agree to pay that, causing you and your staff a great deal of work, especially if a larger chart number pull is requested. When I get a call from Ciox to negotiate a cheaper price, it seems that $20/chart is their limit, if indeed they pay at all. Obviously as mentioned many times, do not send charts until payment is received. If you are still doing paper charts, I would not start any copying or chart preparation until you see the check. 


 


On a final note, in my opinion, do not let their staff in your office to copy your charts. They do not belong in your office. I have heard stories about some of these companies getting a little nosey in doctors’ offices. Obviously, you are not hiding anything but you never know what they can hear from your staff or a patient passing in the hallway. Do not look at this as an opportunity to make some extra money. I do not think it is worth your time.


 


Jack Ressler, DPM, Delray Beach, FL

11/09/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: David Gurvis, DPM


 



I currently charge Ciox $30 per chart. Some charts have a minimal amount of visits, some have many. I win some and lose some. I do not send the requested material until the check is in my hands.


 


David Gurvis, DPM, Avon, IN


11/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Mark Weaver, DPM


 


It has been published that these multiple requests from insurance companies for our records is so that they can upcharge for what they are being paid for procedures we have not billed for. If this is true, and they are not looking for fraud (which seems correct), we must be under-billing. Maybe, if they are getting paid more for our services than WE bill for, we should be privy to that and bill those services we performed as well. If they get paid, should WE not be paid too? 


 


And, more importantly, if I got a huge number of requests ,I would look at my billing policies. Remember, these dudes only make money from paperwork, not patient care. It is just paperwork; they provide no patient care. They do nothing for the patient, the quality of care, and probably nothing for the improvement of healthcare in the country. They profit by BILLIONS of dollars. Don't believe me? UnitedHealthCare is in the top 5% of profitable companies on the S&P over the last ten years; CNBC in 2019 gave them the #1 best profit investment over ten years. This is not an opinion, but actual numbers, black and white.


  


Mark Weaver, DPM, Fort Myers, FL

11/06/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Paul Kesselman, DPM


 



This issue has come up many times in the past. I have two solid arguments against providing this information to Ciox or outside contractors working for third-party payers. Contracts with third-party payers often contain language regarding the need to provide those carriers with charts for claims processing. But the information they are seeking is not auditing your practice nor used to process claims.


 


As for the second argument, I admit it is a bit weaker. Ciox and others are contracted by the third-party payer. Contracts often, but not always, stipulate that the payer may use an agent or subsidiary which may request records and that you consent to that. Again, that may or may not be enforceable because the agent (Ciox) is not using the data to audit your chart. This is purely done for data mining. My advice which worked since this harassment started was to do the following:


 


Develop an EHR template so it's easy to...


 


Editor's note: Dr. Kesselman's extended-length letter can be read here.


11/05/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1A



From: Alan Bass, DPM


 


Like most of us, I have been inundated with chart requests from Ciox. I have now put together a standard letter and invoice that I email back to them. I also include a W-9 (one email response from them was to include that for payment). For the first time ever, I received a payment from them for one of the chart requests. I have also heard from another colleague that they received a payment as well. Stick to your guns; do not send any charts until payment is made.


 


Alan Bass, DPM, Manalapan, NJ

11/05/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1B



From: Eric Lullove, DPM


 



You have a responsibility as part of your contract with the contracted Medicare Advantage contractors to send their assigned third-party companies records of those patients. However, since they are third parties, your contract is not with them. You can charge a copy charge per your specific state statute for chart copying charges and send them an invoice.


 


They will want to assign you a secure email site to send the records. I do not send the records until I have received payment for the charts and can verify the email address will be receipted for the records I send. I have had issues before with EpiSource continuing to contact me regarding charts I have previously sent and their continued fax harassment of chart requests even for patient records that do not belong to me.  


 


At some point, once I have sent the records, I have performed my end of the contract and I ignore the other communications. Keep a record of all emails and communications with the company in case it comes back.


 


Eric Lullove, DPM, Coconut Creek, FL


11/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: MIPS 2020


From: Greg Caringi, DPM


 


I am surprised by how little I have read about MIPS 2020. During a recent online seminar, the lecturer basically said - the quality measures most applicable to podiatry have been eliminated, and the remaining ones are not supported by most EHR systems. He recommended taking any/all exemptions. I know that my participation has nothing to do with the quality of care I provide my patients. MIPS is just another bureaucratic annoyance that takes my time away from patient care. That said, I can't afford any decrease in my Medicare payments.


 


What are my colleagues doing for MIPS 2020? Maybe the most important question - Why is there even a MIPS 2020 program to deal with during the year of COVID-19?  Why is there not a full exemption for this terrible year?


 


Greg Caringi, DPM, Lansdale, PA

11/04/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2


RE: Harassment from Ciox Heath for Chart Requests


From: Jack Ressler, DPM


 


I received a chart request from Ciox health for patient charts. I called them to verify the email of where I need to send an invoice for this service. I sent an invoice as per their protocol. I did not receive any confirmation, but still continue to get ten page faxes requesting charts to the point of feeling harassed. As a group, is there any recourse we can take to prevent this repeated barrage of requests? They call from various telephone numbers and try to negotiate a price per chart, which I tell them is not negotiable. They follow-up with more faxes. If this isn't harassment, I don't know what is.


 


Jack Ressler, DPM, Delray Beach, FL

11/03/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Martin M Pressman, DPM


 


I have posted this information before but apparently it needs more distribution. Compounded Solutions in Pharmacy in Monroe, CT makes 5ml ETOH for injection and charges $70 per vial. 


 


Disclosure: I have no financial relationship with this compounding pharmacy other than purchasing products from them. 


 


Martin M Pressman, DPM, Milford, CT

11/02/2020    

RESPONSES/COMMENTS (NON-CLINICAL)


RE: Purchasing Alcohol for Neuroma Injections


From: Philip Larkins, DPM


 


Earlier this year, there were several posts on PM News regarding where to purchase alcohol for neuroma injections. I will not discuss the merits of this therapy or at what strength the injections should be given. This post is strictly about the availability of the denatured alcohol product. Previously, the main manufacturer of this product was American Reagent. They are no longer able to manufacture this reagent. 


 


A company by the name of Belcher Pharmaceuticals in Florida now has exclusive rights to manufacture and sell a brand name ethyl alcohol injection with the trade name Ablysinol. It is being marketed to cardiologists to treat conditions like hypertrophic obstructive cardiomyopathy and other heart rhythm abnormalities, I believe. They were granted this exclusive right under the Orphan Drug Designation by the FDA. This exclusivity end date is 6/2025. Of course the price for this designer ethyl alcohol is staggering. A whopping $1,000 for one single 5mL ampule, normally sold in packs of 10. Anyone still selling alcohol from other sources in the U.S. is just selling old inventory.  


 


Philip Larkins, DPM, San Diego, CA

10/28/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Joel Lang, DPM


 


While the mask material might let a particle as small as a virus pass through all by itself, unimpeded, that is not the case. The virus is enveloped in a mist of droplets from your breath and those droplets will be trapped by the mask. Just feel the mask when you take it off. Alternatively, let's look at "worst case scenario". Suppose the mask is not effective and you wear it, then you have "inconvenienced" yourself for nothing. Suppose the mask is effective and you do not wear it, then you endanger the lives of the scores of people you encounter in a day and the thousands of people they might encounter in a week.


 


If there is any chance that the mask is effective, do you want to ever feel, that because of your "beliefs", you endangered the life of another, or worse caused their death? This is not a "civil rights" issue; this is a "humanitarian" issue. Sadly, while COVID-19 cases are spiking across the country and over 200,000 have died and thousands more each day, why are we still debating whether to wear masks? Wear a mask everyone and keep yourself and your loved ones safe.


 


Joel Lang, DPM, (retired), Cheverly, MD


 


Editor's note:  We have received many similar posts which can be read here

10/27/2020    

RESPONSES/COMMENTS (NON-CLINICAL)



From: Michael Zapf, DPM, MPH


 



This is in response to Dr. Secord’s October 23 claim that COVID-19 is not more deadly than the flu virus and that masks are worthless. This view is not borne out by science and statistics. As of October 2, 2020, according to the CDD, there have been 299,028 more deaths than would be expected if we compared the death rates to the averages of the last 5 years. 300,000 more deaths? Dr. Secord, what one thing makes this year different from the other 5 years? And the rise did not start until about March or the number would be higher. For a 12-month period, the excess deaths will be well above 400,000 or one in less than every 1,000 people. Most years the number of flu deaths is less than 50,000. Clearly, without successful vaccinations available, Covid-19 is worse than the flu.


 


Yes, the COVID-19 virus is smaller than the holes in our surgical masks but most Covid virus particles ride in on aerosolized droplets that are bigger than the mask holes. The best advice is to wear a mask. 


 


Michael Zapf, DPM, MPH, Agoura Hills, CA


10/26/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 1


RE: An Open Letter to the Council on Podiatric Medical Education


From: Lee C. Rogers, DPM, et al.


 


It's Time to Finally Make Wound Care a Mandatory Part of Podiatric Medicine and Surgery Residency Training.


 


Dear Council on Podiatric Medical Education (CPME) Residency Ad Hoc Advisory Committee, As you are completing the arduous task of the required periodic review and revision of CPME Document 320,1 the Standards and Requirements for Approval of Podiatric Medicine and Surgery Residencies (PMSR), we wish to applaud your efforts on the advancement of podiatry residency training standards over the decades. Today’s podiatrist is well-trained in surgery because of your actions and those of other CPME committees to ensure the standards are being followed. However, there remains one glaring omission from the PMSR training in Document 320, last revised in 2018.


 


Where is wound care? Please note our preference would be to refer to the topic as “tissue repair and wound healing”, since we don’t just care for wounds; we use a combination of...


 


Editor's note: This extended-length letter can be read here. 

10/26/2020    

RESPONSES/COMMENTS (NON-CLINICAL) - PART 2



From: Robert Scott Steinberg, DPM, Brian Kiel, DPM


 


I reject Dr. Secord's assertions, or his referencing articles not in evidence, nor any links. I offer this article.


 


Robert Scott Steinberg, DPM, Schaumburg, IL


 


Dear Dr. Secord, please walk through a hospital E.R. maskless and laughing; then tell me how harmless COVID-19 is. Of course, a virus can pass through a mask, but it limits its dispersion. Denial of its virulence has killed thousands. The theory you espoused has been repeated by certain politicians but the opposite is stated by experts like Dr. Fauci. I think I will take his word for it.


 


Brian Kiel, DPM, Memphis, TN
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