Podiatry Management Online


Podiatry Management Online
Podiatry Management Online



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Query: Limiting Practice to Vaccinated Patients


I am considering limiting my practice to patients who have been vaccinated against COVID-19, now that vaccines are readily available to anyone who wants them. I have written to the NYSPMA attorney, but have not gotten a clear answer. Has anyone done this? I imagine I would need to send written notice to all my patients of this new policy and give the unvaccinated ones an opportunity to find a new podiatrist in a reasonable amount of time.


Howard R. Fox, DPM, Staten Island, NY

Other messages in this thread:



Query: Recoding Tele-Medicine Visits


How do other podiatrists record their telemedicine visits in a HIPAA-compliant inexpensive way?


Daniel Chaskin, DPM, Ridgewood, NY



Query: Victim of Employee Theft

Recently, I read an article online about emplyee theft and decided to reconcile my recent cash deposits of co-pays and deductibles. To my surprise, I noticed weekly decrepanies of $20 to $50 a week. While this is a relatively small amount against total revenue, it is still theft.

Do I confront the longtime employee responsible? Do I go to the police? Do I fire her immediately? Any recommendations will be appreciated.

Name Withheld



Query: Can a Podiatrist Be a Medical Director in Florida?


I'm an instructor at a college in Florida that provides certified EMTs continuing education credits. They have a college-sponsored organization that provides stabilizing care in an emergency as an adjunct to campus security. I have been asked to act as their medical director  (I will not be providing care, just overseeing the organization). 


I realize we are considered physicians by the federal government (therefore meeting the requirement for medical director) however, could an issue be raised that this goes beyond the scope of a podiatrist? If not, does accepting this position create any unusual liability issues? I would like to accept the position as I feel it helps advance our visibility as a profession.


Name Withheld



Query: Reporting Disability Fraud


Anyone can Google Medicare fraud and find dozens of resources to report a medical provider for possible fraud. What are the resources and what policing is involved in patients on disability? I just had a 50 year old male on disability for back surgery, who plays on a contracted travel softball team several days a week. He seems perfectly capable of working to me. To whom do I report this?


Name Withheld



Query: NY State Mandate for Healthcare Providers to be Vaccinated 


Under NY’s new mandate, would the staff members at the front desk area who directly deal with patients: processing forms, taking payments, making appointments, etc. fall under that mandate? 


Sam Bell, DPM, Schenectady, NY


Editor's comment: PM News does not provide legal advice. "Governor Andrew M. Cuomo has announced that all healthcare workers in New York State, including staff at hospitals and long-term care facilities (LTCF), including nursing homes, adult care, and other congregate care settings, will be required to be vaccinated against COVID-19 by Monday, September 27. The State Department of Health will issue Section 16 Orders requiring all hospital, LTCF, and nursing homes to develop and implement a policy mandating employee vaccinations, with limited exceptions for those with religious or medical reasons." Note: There is no mention of private physician's, dentist's, or podiatrist's offices.



Query: CIOX Redux 


My request for payment to submit patient charts for review has been denied by CIOX representing United Healthcare insurance. My fee is $10 per chart with a minimum of 4 pages per chart for 60 charts. Mine is a small solo practice and it takes one office assistant significant time to pull charts copy, collate, and re-file them. The CIOX representative offered copy paper and shipping postage and/or onsite copying by their technician. I declined their offer on the advice of legal counsel to avoid HIPAA exposure.


What are the repercussions of non-compliance if I don't forward records as requested?


John Moglia, DPM, Berkeley Hts. NJ



Query: Magazines and COVID-19


Are we allowed to put magazines back out in our office?


Sam Bell, DPM, Schenectady, NY



Query: Dealing with Unvaccinated Staff


How are others dealing with staff that are either hesitant or refusing to get vaccinated for COVID-19?   


Name Withheld



Query: Hospital Discrimination


My hospital is allowing orthopedics to use antibiotic bone beads and not allowing podiatry to do so. Any options? 


Scott Henry, DPM, Gettysburg, PA



Query: COVID-19 Restrictons in New York


For New York State, are there any COVID-19 restrictions for the office besides masks, cleaning, and distancing? 


Sam Bell, DPM, Schenectady, NY


Editor's Comment: PM News does not provide legal advice. In general, all states follow CDC Guidelines; however... each state, county, and municipality has jurisdiction to implement rules and regulations, which often vary depending on the current infection rate in a particular area. Since this is a moving target, it's best to stay informed of any changes in your town or city. If you have any doubts, it is recommended that you err on the side of extra caution.



Query: Recordkeeping Requirements When Retiring 


As I prepare for retirement, what are my obligations regarding retaining patients' paper charts? Notice to patients? Notice in local paper vs. individual letters? Storage options? Are there penalties for non-compliance? 


John Moglia, DPM, Berkeley Heights, NJ


Editor's Comment: PM News does not provide legal advice. Most practice management experts recommend that you keep records for seven years past the last patient visit. The one exception is for children. In New Jersey, the statute of limitations for minor children does not begin running until the child’s 18th birthday. We know of no rules requiring a specific way to notify patients. The penalty for not storing records is that you run the risk of not being able to adequately defend yourself against a malpractice suit or an insurance audit. 



Query: Paying for an Interpreter for a Hearing-Impaired Patient


A deaf patient called and requested an appointment. We made it, and then the patient requested a sign language interpreter be present. The interpreter charges $160 a visit. I assume I have to supply an interpreter. Is it okay for it to be a virtual video interpreter instead of an in-person one? Do Medicare and Medicaid pay for this service? If the patient misses the appointment, who is responsible for paying the interpreter?


Editor's comment: PM News does not provide legal advice. Under the American with Disabilities Act (ADA), a provider is responsible for the costs of a requested interpreter. This cost is not covered by Medicare or Medicaid and must be paid even if the patient is a no-show. You can use a virtual video interpreter as long as the patient consents to it.



Query: Subpoena to Produce Documents


When served with a subpoena to produce documents for a patient suing a thirdparty (like an insurance company or an employer) can you charge for the cost of production of these documents? If so, then how much? 


Mark Davids, DPM, Orange City, FL


Editor's Comment: PM News does not provide legal advice. The short answer is yes, you are generally allowed to charge a fee based on state law. In Florida it's $1.00 per page for the first 25 pages and $.25 for each page thereafter Rule 64B8-10.003, Florida Administrative Code. For a more complete discussion of this topic, see You just received a subpoena. Now what?



Query: When an Insurance Company Wrongly Sends a Check to a Patient


We evaluated and treated a patient for an auto claim with State Farm. The patient is on disability. State Farm issued payment for our services directly to the patient. He has refused to respond to messages, statements, etc. The insurance agent claims to have no recourse in getting us paid for this service. Can we pursue payment directly from the agent? What recourse do we have?


Editor's comment: PM News does not provide legal advice. Since the contract for services was between you and the insurance company, your first course of action is to commence legal action against the insurance company. If the amount is relatively small, your best bet may be small claims court. Filing fees are usually nominal. You should add the patient as a third-party defendant. When the patient receives the summons, you will likely be paid as courts generally do not look favorably on such unjust enrichment.  



Query: Billing Policy for New Hires


When hiring an associate podiatrist in our practice, we have not allowed the new provider to see patients for whom they were not yet on the particular insurance panel (both primary and secondary insurance). We do pay podiatrists at their salary rate during this credentialing period which can range from 4-6 months. The rationale for this policy is that the provider would not be eligible for payment by the carrier and to bill the patient for an out-of-network service would be misleading to our patients.


I continue to hear from our new associates that their peers are hired and are billing immediately during the credentialing process under the name of one of their senior practitioners. I am uncertain whether the senior practitioner is signing or co-signing the chart at these practices as sending the claim in under the senior practitioners name would be fraudulent. Is anyone aware of a standard or acceptable practice relative to allowing a new hire to see patients in a practice prior to being credentialed by an insurance carrier?



Query: When Office Staff Refuse to Get Immunized


How are other colleagues addressing this please? I understand that this is a voluntary decision on everyone's part and no one is being forced to be immunized, but if a staff member refuses to get the COVID-19 immunization(s) and is now a potential liability in the office as it pertains to patients getting exposed from that employee, does that expose us in any way to potential litigation? 


Name Withheld  


Editor's Comment: PM News does not provide legal advice. As a matter of liability, it would be nearly impossible for patients to prove conclusively that they got COVID-19 from your office as opposed to elsewhere. If you are concerned about an unvaccinated employee, one solution is to re-assign that employee to non-patient related duties such as working in the back office. The bottom line is to assiduously follow CDC guidelines on the use of PPE, social distancing, etc. 



Query: Are Gloves Necessary to Administer COVID-19 Vaccine?


I have noticed some people receiving the COVID-19 vaccine by people who are not gloved. All podiatrists giving injections for whatever have always worn gloves. Glove wearing for all procedures including routine foot care became the norm sometimes in the 1990s. What are your thoughts?            


Steven Finer, DPM, Philadelphia, PA


Editor's comment: PM News does not provide legal advice. According to CDC guidelines, "gloves are not recommended for most vaccination administrations and are optional for the COVID-19 vaccine unless the person administering the vaccine is likely to come into contact with potentially infectious body fluids or has open lesions on their hands. 



Query: Obligation to See a Patient One Week Post-COVID-19


An established patient calls for an appointment with an infected ingrown toenail. She tested positive for COVID-19 a week prior, but has no acute COVID-19 symptoms. Must I see this patient? After her treatment, must I quarantine myself and/or get tested? How about my staff?


John Moglia, DPM, Berkeley Heights, NJ



Query: FMLA Requests


My office has been bombarded with Family and Medical Leave Act (FMLA) requests over the past couple of months. This is new to me. I think I have seen 1 or 2 of these requests TOTAL in 15 years, now I am getting about 1 per day! I recently found out that (at least in my area) employers are requiring completed FMLA forms for any employee who will be out of work for more than 3 days in a row. It doesn’t matter if the employee has accrued time off; they still have to have the forms filled out.


I am not sure if the uptick is due to the Covid crisis or if anything else caused this change, but it is not something my office was prepared for. Filling out FMLA forms takes up more time than records requests and we all know how much of a pain they can be. I don’t believe FMLA was ever designed to be used in this way. Are any of you experiencing this problem? If so, how are you handling it?


Dave Williams, DPM, El Paso, TX



Query: Audits and Administrative Defense Coverage


As you may have heard, many of our colleagues have been undergoing both pre-payment and post-payment audits. For those of you who have had to deal with these audits, what has been your experience with your malpractice carrier with the use of your administrative defense coverage (ADC)? For those of you who had to pay back any money, were you aware that your ADC coverage was only for your defense and not payment of adverse findings? Were you then surcharged by your malpractice carrier?


Alan Bass, DPM, CPC, Manalapan, NJ



Query: How Much to Charge Ciox for Chart Requests


What is a fair fee to charge Ciox for chart requests considering staff time diverted from regular duties. Paper chart vs. EHR? Copying involves more than simply photocopying in my case. I still use paper, so staff must pull chart, disassemble demographics sheet stapled to folder, copy all pertinent sheets, then reassemble. I review each chart to be sure all are signed and dated as required. I charge $10 chart and have received my fee after refusing to allow their rep to come to my office to scan due to COVID-19 and HIPAA concerns. I have read previous responses of up to $25 chart vs. a $2 per page fee.


John Moglia, DPM, Berkeley Hts, NJ



Query: Can Podiatrists Do COVID-19 Testing in Their Offices?

From: Elliot Udell, DPM


I just got a call from a company trying to sell me COVID-19 rapid response tests. This involves taking a drop of the patient’s blood and determining if there are antibodies. The salesman assured me that I am allowed to do this test and can be reimbursed for doing it. He said there was a waiver that would allow our office to do this test. Before I bought the tests, I told him I would run it past my colleagues to determine if indeed podiatrists are allowed to do this test. Are we?


Elliot Udell, DPM, Hicksville, NY



Query: Off-Label Prescriptions for Non-FDA-Approved Drugs


A patient of mine has erythromelalgia and came in with a paper showing anecdotal evidence that a new med used to treat migraines helps. I was willing to give her an off-label prescription but to my chagrin found that it is only available in Europe and Canada and is not FDA-Approved. Here is the legal question: Could I give her a prescription and have her fill it in Canada? Is this opening up a can of worms since it is not approved yet in the USA?


Elliot Udell, DPM, Hicksville, NY


Editor’s Comment: PM News does not provide legal advice. It is not permissible to prescribe non-FDA-approved drugs except under certain exceptions which do not apply to podiatric use. If you prescribe any FDA-approved medicine off-label, you must inform the patient. It’s a good idea to have patients receiving off-label medicines acknowledge in writing that they are aware that the drug has not been approved for the treatment you are prescribing it for.



Query: Which States Allow DPMs to Test for COVID-19 


Which states have emergency legislation allowing DPMs to provide COVID-19 testing? If your state allows this, please provide a link. Here is an example from Pennsylvania.


Daniel Chaskin, DPM, Ridgewood, NY



Query: Rebates from Suppliers?         


I am looking for advice/information from other podiatry offices regarding purchasing a product from a supplier who then, at month’s end, issues a rebate to me. It is not supposed to be a rebate on each product purchased, but a rebate based on volume purchased from them for the past month. This happens to be for a wound care product that is reimbursed by insurance (including Medicare). My question is:  “Is this allowed and if so, how do you do the accounting?”


Gerald W. Torgesen, DPM, Henderson, NV

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