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From: Elliot Udell, DPM


Not having to travel for seminars and not having to rent space for seminar conference space, paints a rosy picture of all of us paying less for our continuing education seminars. Having just attended and lectured at a virtual seminar, I can vouch that as a participant, I was able to hear the speakers better than had I been to an in person seminar. I was also more comfortable sitting in the chair I am now sitting at than some moldy chair in some far away hotel. 


There is, however, another side to this issue. We are all linked in our economy, and hotels - even resort hotels - are dependent upon convention business to survive. If  post-COVID-19 conventions find that Zoom or "Go To Meetings" seminars make more sense than live seminars, we can expect many resorts to go under in the years to come. 


Elliot Udell, DPM, Hicksville, NY

Other messages in this thread:



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



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



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



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.



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



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



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



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



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. 



RE: Jeffrey Toobin, Esq. “Clearly not a Foot”

From: Bret M. Ribotsky, DPM


I sit back today with the majority of our profession with a big smile,  It was a little over 10 years ago when the same Jeffrey Toobin from CNN and The New Yorker magazine published an article where he referred to podiatrists as “three steps below a dentist.” I took the opportunity to interview him on Meet the Masters in 2010.


During the 10 minute interview, he acknowledged that a podiatrist saved his mother's (a national CBS Reporter) life and was appreciative of our profession, but he was unwilling to retract or say he would do anything different if given the chance to do again. Thus, I was grinning from ear to ear at the news of him caught in the act of masturbation on a Zoom call. An anonymous source who was on the Zoom call said, “he clearly did not have a foot.” - Karma .


Bret M. Ribotsky, DPM, Boca Raton, FL



From: Denis LeBlang, DPM, Nick Turner


There is a company in Los Angeles called Osada, Inc. They have the equipment that you need to drive the Shannon 44 burr. You will be happy with their equipment. 


Denis LeBlang, DPM, Congers, NY


Many physicians have opted to use the Osada Portable All-in-One PEDO-30W drill unit along with the Shannon for in-office MIS. DocShop Pro carries this unit and all other Osada units. Additional saw options are available as well to complement your Shannon.


Disclosure: I am the Vice President of DocShop Pro.


Nick Turner



RE: If Falsely Accused - What Would You Do?

From: Martin R. Taubman, DPM, MBA


Friday, August 17, 2012 ended the week-long ordeal of one of the most damaging series of San Diego County fires in local history. Clouds of ash blanketed the city leaving an oily, gray residue on our cars, lawns, and streets for most of the week. People were evacuated from their homes; some homes burned to the ground. In fact, one of our fellow podiatrist’s home was lost to the fire and had to be rebuilt. People died. Lake Cuyamaca and its surroundings were devastated.


Driving through its prior verdant scenery was heartbreaking—the trees stood like broken, blackened skeletons amidst a barren, burned earth. The canopy of trees which covered miles of Highway 79 leading to the lake from Route 8 was gone. It was estimated it would take 100 years for the area to return to its previous pristine grandeur. I’ll never forget it.


However, there was another event that occurred that fateful Friday, and it will remain etched into my memory with at least the same vivid horror (or worse) as...


Editor's note: Dr. Taubman's extended-length post can be read here.



RE: When a Patient Sexually Harasses An Employee

From: Elliot Udell, DPM


This past week, the Nassau County Podiatric Medical Association sponsored a lecture on dealing with sexual harassment issues. The main thrust of the presentation dealt with potential problems between employees and employers in the workplace as well as potential problems between workers regarding various forms of sexual harassment and discrimination. It was an excellent presentation by Mathew Feldman, JD and the Long Island team.  


Two years ago, one of my employees told me that one of my long-time male patients made some unacceptable verbal remarks to her of a sexual nature. There were no witnesses. My gut feeling at the time was to permanently "show the patient the door." I did let my employee know that what he said was totally unacceptable; however, since there were no witnesses, if I confronted the patient, would I not be opening myself and even my employee to a lawsuit? The patient could say in court that I falsely accused him and damaged his reputation, and since I was not there, I caused him pain and  embarrassment based on hearsay. I am certain that I am not alone and this has happened in other offices. How have others handled this problem?


Elliot Udell, DPM, Hicksville, NY 



RE: Medicare Advantage Companies Attempt to Game System by Overbilling CMS $2B (Paul Kesselman, DPM)

From: Ron Freireich, DPM


Here is from a post of mine on this very topic over two years ago. I start out by saying, "What a crime!" In it's simplest terms, it's called fraud. When a provider commits fraud of this magnitude, they are fined and thrown out of the Medicare system for life. If you read the OIG's 45-page report, their recommendations are basically a slap on the wrist as Dr. Kesselman points out. These insurance companies are trying to make patients look sicker on paper solely for their financial gain. These audits do not benefit the patient, the physician, or the medical system in general but are a continuous burden on our practices. These insurance companies should be held accountable like anyone else that commits fraud. What advantage are these advantage plans anyway?


Ron Freireich, DPM, Cleveland, OH 



From: Tim Shea, DPM


Unfortunately, over the past number of years, I have been seeing an increasing number of patients who act out inappropriately to staff. Having practiced for greater than 45 years, it used to be very infrequent that I would have to deal with this. Now is a different story. I don't know the reason: Entitlement? Poor social behavior habits? The reality is that this type of behavior creates a hostile environment for the office .


Recently, a seminar in California listed all the reasons why you can be fined for "hostile environment" by the state, and I don't know if this is one of them, but I prefer not to take the chance. So if this kind of behavior is reported by staff to me or to the office manager, out comes the well-constructed (by PICA) discharge letter of inappropriate behavior, and the patient is discharged immediately. There is no more grace period or any reason to discuss why it is unacceptable. Your staff demands your protection, and this is an example that you must set.


Tim Shea, DPM, Concord, CA



From: Jack Ressler, DPM


There is a fine line in dealing with a rude patient. On one hand, you do have to respect the patient’s opinions. Probably more importantly, you have to go to bat for your staff if they are right. I had a very interesting experience in my office where my staff member was both right and wrong on two different occasions. The first incident occurred when a patient did not get their way when making an appointment and ended up calling my receptionist an idiot. This patient did come back to the office after apologizing. It took all of two minutes for the patient to rehash this incident and again called my receptionist an idiot. I proceeded to tell the patient to leave and never come back. This was done before treatment. I must admit, dismissing a patient like this from my practice felt great, and was the first and only time I ever did that.


The second occasion occurred when the same staff member left a patient who was in severe pain in the waiting room because they were early for their appointment time. This patient did confront me in private while in the treatment room. I assured the patient that I will discuss this with the staff member. Although she was wrong, I made the mistake of asking her to come into the treatment room to discuss the incident in front of the patient. She had no explanation for her reasoning. Later in private, I diplomatically explained to her why she was wrong. She obviously was not in agreement because three weeks later, she quit citing this incident as her reason. In most cases, your staff is generally going to be right and they must be defended against unruly patients.


Jack Ressler, DPM, Delray Beach, FL



From: Judith Rubin, DPM


I have noticed that when I have been going to doctors’ offices over the past few years, I am also asked to put in a credit card that will be automatically billed for no show fees. Since we call all our patients one day before by phone and send a text, there is absolutely no reason for patients not to tell our office that they can’t make. Of course, there are certain circumstances we allow for like fever that morning, etc. It has cut down tremendously on no show patients. It even helps when patients have balances.


We always call and ask if they would like to use their credit cards on file or change their card. Some don’t want to give us a credit card on their paperwork. They are afraid we will bill them unnecessarily. My office manager’s comeback is “do you order things online?” Of course their answer is always “yes”. She says to them “I rest my case.” Note: There are some doctors who are only accepting cash and checks now because the rates on credit card charges are going up. 


Judith Rubin, DPM, Cypress, TX



From:  Elliot Udell, DPM


I am a caregiver for my parents. This means taking them to a plethora of doctors. Many have signs saying that unless 24 hours notice of cancellation is given, there will be a charge. In my situation, between urgent care visits, doctors’ visits, and actual hospital ER and hospital admissions, we have had to miss many appointments. To date, none of the physicians we go to have "fined" us for missing appointments. If they did, we would have to choose a different doctor in the same specialty. 


Wearing the "shoe on the other foot", I am not thrilled when a patient does not show without notice, but we do not charge patients. We do keep a record of who tends to be a "no show" and if it is often, we will tend to "overbook" that patient knowing that there is a likelihood that the person will be a no show. 


Elliot Udell, DPM, Hicksville, NY



From: Keith L. Gurnick, DPM


Some, but not all patients have little respect for doctors and your time and office space commitment to them. If you force patients to give you an upfront "scheduling" deposit on their credit card and then they do not show up, too many of them will send in a dispute to their credit card company who will almost always side in favor of the patient and refund the money you took as a deposit. Credit card companies almost always side with the cardholder. That is just the way it works, and it just isn't worth the time or trouble to do what you are suggesting.


If you want to charge for "no shows", then you should do it the old fashion way. Simply post your policy in your office reception room, and also include it with your new patient intake paper work and also any mailings to patients. Inform your patients in advance on the phone when they schedule, and enforce your policy by sending a reasonable bill for the "no shows" or late cancellations, and enforce your policy by collecting the money.


Keith L. Gurnick, DPM, Los Angeles, CA



RE: Cigna Policy on NY Regulatory Restrictions on Balance Billing For PPE

From: Steve Abraham, DPM


From Cigna: “Effective August 5, 2020, the State of New York implemented a mandate that healthcare entities, such as Cigna, are required to notify participating providers that they should not charge our customers any fees for protective personal equipment (PPE) that exceed that customer’s normal financial responsibility.


Accordingly, if such fees are charged, Cigna is obligated to recoup those fees on behalf of the customer. If you have charged a Cigna customer for any PPE-related fees, we request that you immediately reimburse that customer for any funds that exceed their normal financial responsibility.


If a customer notifies Cigna of balance billing for PPE by a participating provider, a complaint will be filed on behalf of the customer and a Cigna representative will contact the treating office to seek reimbursement.”


Steve Abraham, DPM, NY, NY



From: Jack Ressler, DPM


For many years, we’ve been purging x-ray film in our office, and we found less and less companies even wanting old x-ray film, let alone paying you for the silver content. The fact that a certified company would come out to our office and take the film for free and legally dispose of it was more valuable than rarely finding a company that would pay you for the silver content.


Jack Ressler,  DPM, Delray Beach, FL



RE: Source for Phenol? (Jane E. Graebner, DPM)

From: Mark Stempler, DPM, Jim Ricketti, DPM


I recently bought a large bottle of phenol only to find out that it is not considered medical grade. I then ordered a large bottle from Schein Medical.


Mark Stempler, DPM, Staten Island, NY


Why is anyone not using my Phenol EZ Swabs for P&As? A bottle of phenol does not last, and the cost versus the ease of Pheno EZ Swabs are a no-brainer.


Disclosure: I am the inventor of the Swabs


Jim Ricketti, DPM, Hamilton Sq, NJ



From: Robert S. Schwartz, CPed


To accomplish your goal, consider adding a lateral flare and buttress to his/her footwear. High-tops work best. Lateral stability is hard to achieve even in an Arizona AFO unless there is extra lateral support. Elevate for equinus conditions. And don't forget about rocker-soles for limited sagittal plane motion. Shoe inserts play a big role, as well.


Robert S. Schwartz, CPed, NY, NY



From: Pete Harvey, DPM, Howard R. Fox, DPM, Carla Ross


I have always had my local pharmacy mix fresh 88% phenol which I replace every 2 months. The solution should always be almost clear and not yellowish.


Pete Harvey, DPM, Wichita Falls, TX 


Fisher Scientific has 99% phenol crystals in bottles of 100g or 500g. You’ll need to fax them your state license and a letter on your letterhead of your intended use. It ships by freight (corrosive).


Howard R. Fox, DPM, Staten Island, NY


Phenol can be ordered directly from Medisca:


MFG Item # Item Description Pack Quantity Price

38779193805 PHENOL LIQUID USP (LIQUEFIED) BO 100 $12.35

38779193808 PHENOL LIQUID USP (LIQUEFIED) BO 495 $34.40


Carla Ross, Talar Medical



From: Dale Feinberg, DPM


As Dr. Sherman pointed out, in the future, online conferences will have no travel costs associated with them. Since the principals will not have associated costs to produce the seminars, I expect the costs of their seminars should be reduced by at least 50%. We will all remain safe and the monies we all save can be spent when everything opens up again at the bar.


Dale Feinberg, DPM, Yuma, AZ

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