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01/27/2021
RESPONSES/COMMENTS (DME) - PART 1A
From: Daniel Jones, DPM
I remember when I was in school. There was 'Vision 2015'. It essentially stated that the goal of podiatry was to have parity with MDs and DOs by 2015. Yet here we are, some 6 years later, still seen as second class physicians, or "allied healthcare providers". Even with the excellent work of the APMA, a podiatrist serving in Congress, and mandatory 3-year residencies (the same as PCPs nationwide), we still have to have a 'real doctor' sign off on our patients. Who knows our patients’ feet better than us? Who sees our diabetic patients more than us?
The point is this: We should be able to sign for the shoes ourselves. My staff and I spend countless hours explaining to our patients that the NP and PA they see for their primary care doesn't 'count' in getting shoes signed for. This also creates a potential rift between podiatrists and NPs and PAs, who see us sending patients they referred to us to another provider for this visit. By signing for ourselves, it eliminates barriers to diabetic ulcer prevention and lets our patients see their PCPs without burdening the system with unnecessary MD/DO foot checks.
For better or worse, there will be political changes to the practice of medicine. Likely, one of these multi-thousand page bills will be signed into law. Can we have just one of those pages give parity to DPMs? Title XIX has hindered us long enough. It's time for DPMs to take their seat at the table with MDs and DOs.
Daniel Jones, DPM, Casper, WY
Other messages in this thread:
06/01/2023
RESPONSES/COMMENTS (DME) - PART 1A
From: Terry Reed, C Ped
Currently, CMS is doing massive audits on diabetic shoes and are very picky about what they allow. An NP may conduct the exam but it has to be signed by the MD or DO overseeing the patient's diabetic plan of service, and not just signed. There must be a statement such as, "I agree with the above findings" or CMS will reject it.
Also, the auditors will claim that the MD or DO is not truly overseeing the patient if they have not personally seen the patient in the past six months. In other words, people in rural areas who go to a clinic manned by an NP who has their practice overseen by an MD or DO are flat out of luck because they never actually see that doctor.
Terry Reed, CPed, Wynne, AR
05/31/2023
RESPONSES/COMMENTS (DME) - PART 1A
From: Paul Kesselman, DPM
CMS attempts to facilitate access for therapeutic shoes to patients who only see PAs or an NPs has been a flop. It also has confused the auditors at every level, created a larger paperwork trail. Even my fellow DME council members continue to flood my phone and email box just having reviewed this issue during a council meeting. So to try to give a straight answer covering every scenario in this format would be nearly impossible. This is what a PA can do:
If you are the supplier and prescriber: They (the PA) can perform a systems exam, sign the supervising physician statement, and attest agreement with your notes. However, every single one of those documents must be co-signed and dated by the...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
05/17/2021
RESPONSES/COMMENTS (DME) - PART 1A
From: Lawrence Rubin, DPM
I understand that optometrists are also having a supply chain issue getting timely delivery of custom eyeglass frames and lenses. It appears that the worldwide impact of COVID-19 is resulting in delays due to fewer employees on the production end in the factories, and also fewer workers on the job in the other links of the supply chain.
Lawrence Rubin, DPM, Las Vegas, NV
01/29/2021
RESPONSES/COMMENTS (DME) - PART 1A
From: Billy Dabdoub, DPM
I want to thank my colleagues for raising this important issue at the beginning of this congressional session. I’ll start by recommending that they can begin to educate themselves on this and other issues impacting our profession by becoming members of their state component and members of APMA. Our professional associations are our voice in our state and national capitals, and they keep us informed about what’s happening to our profession and the threats which we must overcome.
APMA has been actively working to address the problems with the Medicare Therapeutic Shoe Program for patients with diabetes for more than a decade. Several resolutions have been passed over the years by the APMA House of Delegates to address this issue and to reinforce the importance and priority that the profession places on...
Editor's note: Dr. Dabdoub's extended-length letter can be read here.
01/28/2021
RESPONSES/COMMENTS (DME) - PART 1A
From: Steven Finer, DPM
You are paying for the sins of others. When I was in practice, patients would come in with shoes from suspect private stores where the shoes were obviously not custom-molded. The inserts came right off the shelf with no corrections for lesions, etc. I repeatedly would tell the patient to go back and complain. One showed me a pair where some charlatan placed a one cent rubber pad inside and charged him $80.
I had a family of patients that would brag to me as to the number of shoes they could get. Read old OIG reports about the abuse with braces, scooters, TENS units, and power chairs. As an ethical practitioner, you are being inundated with paperwork for saving people's feet. Blame the system. The free lunch is never free.
Steven Finer, DPM, Philadelphia, PA
07/28/2020
RESPONSES/COMMENTS (DME) - PART 1A
From: Doug Richie, DPM, Brad Katzman, DPM
The Richie Brace family of lab distributors offer a gauntlet AFO with the patented Arch Suspender: Also, the Richie Brace labs offer the California AFO which is a unique gauntlet brace incorporating the Arch Suspender without any laces.
Doug Richie, DPM, Seal Beach, CA
Check out Biostep. They are located in Panorama City, California. They make excellent orthotics and custom braces at extremely reasonable pricing with excellent products and service.
Brad Katzman, DPM, Chino Hills, CA
04/03/2018
RESPONSES/COMMENTS (DME) - PART 1A
From: Paul Kesselman, DPM
CMS instituted a re-validation fee for DMEPOS providers five or more years ago. Since this re-validation is only for a period of three years, I am curious how you may have re-validated without having to pay the piper when you last re-validated. CMS requires validation payment(s) from certain types of providers, which is why as physicians under Medicare we don't pay. However, the NSC which enrolls suppliers doesn't have a special category entitled "Physician Suppliers". DPMs, MDs, or DOs are considered suppliers and are offered no special exemption. Thus, you must pay the triennial payment.
The NSC will not even initiate the re-validation process until that fee is paid.
Paul Kesselman, DPM, Woodside, NY
10/27/2016
RESPONSES/COMMENTS (DME) - PART 1A
From: Paul Kesselman, DPM
Surgical shoes are a non-issue and are a cash product which is not covered by Medicare and almost every third-party payer. Therefore, there is absolutely no reason why you could not dispense this item to your patient prior to surgery. The profit on these is slim, with most providers not charging more than $30 and the lowest cost I've seen being about $5, only usually leaving at most a $25 profit.
When it comes to CAM walkers, however, that is entirely another story. One must also divide this discussion into non-Medicare and Medicare. Most third-party non-Medicare payers will only pay for such an item when there is medical necessity; however, because each payer operates under its own rules, one should...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
03/02/2016
RESPONSES/COMMENTS (DME) - PART 1A
From: Paul Kesselman, DPM
While I was not on this call due to a scheduling conflict, I was told that the meeting with NGS went very well. This meeting was arranged for by APMA and open to all. The presenters of NGS were members of the Provider Outreach and Education (POE) team, not auditors or a Carrier Medical Director (CMD).
Prior to this call, one week earlier, a conference call took place with Dr. Hoover (Region C CMD) and supervisory auditors from CGS, along with some APMA staff and a few others selected by APMA. This call was initiated by the Georgia Carrier Advisory Committee rep, Dr. Len La Russa who himself had 12 of 16 claims slated to go to the ALJ pulled and ordered paid by the supervisor of the auditing staff at CGS. She had researched these claims and found...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
12/26/2015
RESPONSES/COMMENTS (DME) - PART 1A
From: Ira R. Cohen, DPM
Kudos to Dr. Kesselman for shedding light on this despicable practice by auditors. It is time we as a profession supply Dr. Kesselman and APMA with all the ammunition they need to end these unfair practices once and for all.
Ira R. Cohen, DPM, Downey, CA
01/22/2015
RESPONSES/COMMENTS (DME) - PART 1A
From: Keith L. Gurnick, DPM
My office is located in a hospital adjacent medical building (all on the same campus) and there are many covenants, conditions, and restrictions (commonly called CC&Rs), including door signage written into my lease. The door signage restrictions conflicted with the DME requirements, so I too had a problem with this. I resolved the problem as follows. Maybe this technique will assist you.
First, I posted a paper sign indicating my days and hours of operation, and they promptly removed it and sent me a letter that I...
Editor's note: Dr. Gurnick's extended-length letter can be read here.
08/12/2014
RESPONSES/COMMENTS (DME) - PART 1A
From: Martin V. Sloan, DPM
We, too, verify coverage for orthotics (and all services) for all patients prior to providing those services. Although we haven't had the problem Dr. Orman mentions with UHC, we have had multiple problems with many of the BCBS plans. Approximately 40% of the time BCBS refuses payment after first confirming orthotics are a covered item under the patient's insurance. We appeal and they sometimes pay. When they refuse to honor what they said, we request a copy of the recorded phone call (all phone calls are recorded by them) and threaten to turn them over to the Texas State Insurance Board for review. They usually end up paying, but this can take several months.
08/04/2014
RESPONSES/COMMENTS (DME) - PART 1A
From: Paul Kesselman, DPM
"Hours by appointment only" are only allowed to certain supplier categories. Physicians are exempt from the thirty hour rule, but not the requirement of posting certain hours. I don't see why it would be a problem for you to post open hours and by appointment hours so long as you do post those hours you are definitely open. I have forwarded that issue to the NSC for further comment.
The rationale behind this specific requirement escapes me and needs an immediate response to the NSC from the...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
04/25/2014
RESPONSES/COMMENTS (DME) - PART 1A
RE: Payment for Diabetic Therapeutic Shoes (Paul Kesselman, DPM)
From: Eddie Davis, DPM, Glenn B. Gastwirth, DPM
Coverage for therapeutic shoes for eligible diabetic Medicare recipients was enacted by Congress in 1998. It is the law of the land. Failure of Medicare carriers to comply violates that law, plain and simple. Of course, we realize that agencies charged with creating regulations and compliance with such laws have an enormous amount of latitude, largely extra-Constitutional, in the application of laws. Dr. Kesselman, as always, has performed an exemplary analysis of the issues concerning the current state of diabetic shoe coverage in his recent post.
Agency regulations that involve a de facto reversal of a law duly passed by both houses of Congress and signed into law by the President require a vigorous legal challenge. I am not sure where APMA is on this issue, but such a challenge should be performed with the assistance of various interested parties such as the American Diabetes Association.
APMA is keenly aware of and actively engaged in all issues involving the Medicare therapeutic shoe program. It should be noted that Paul Kesselman is the DME special expert on the APMA Health Policy and Practice Committee. He is also the coordinator of the committee’s DME Workgroup.
The Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians (HELLPP) Act, which we have repeatedly asked our members to support by contacting their Congressman and Senators, includes provisions to clarify and reduce some of the burdensome requirements of the therapeutic shoe program.
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