12/04/2023    Janet McCormick, MS

Richard M. Maleski, DPM, RPh

I agree with Dr. Maleski that Medicare and
insurance patients should not have services in a
podiatry practice by an MNT. If a patient is in
treatment, they are only within the scope of care
for RFC by the podiatrist, period, and a
podiatrist that is billing insurance and Medicare
for services performed by an MNT is billing
improperly and fraudulently. This is stated many
times in the MNT program and graduates are
instructed in this clearly. Sadly, some
podiatrists bypass this when the client gets to
the counter and bill the care anyhow to insurance
or Medicare. I experienced this myself in a
podiatry practice once and had to insist on paying
for the RFC I had that day!

Since 1995, the patients who are eligible to have
their RFC billed to insurance and Medicare have
reduced in percentage dramatically due to a ruling
by Medicare and have become cash RFC. Many of the
patients are no longer eligible for this benefit,
These "well" patients are the ones who go to the
MNT for their RFC and pedicures. These cash
services by an MNT are legal and are a full
payment the practice can depend on and enjoy, not
the puny reimbursement by insurance and Medicare
that is reluctantly paid. When the podiatrists
market to their clientele their recommendations
for safe pedicures and RFC in their practice, a
very high number immediately come in, though they
are well and do not need foot care at that moment.
Safe cosmetic care has become a high priority
among many people in communities.

I do believe it is out and out fraud to bill an
MNT service to insurance or Medicare. It is clear
who an MNT can perform care on in a practice.
Podiatrists view MNTs as a way to get patients
into their office on a regular basis, a positive
in every way, both in cash-on-the-counter and in
preventive care. It also keeps them out of salons
with poor sanitation practices and having services
by nail technicians with no training in preventive
care for the chronically ill. Further, having an
MNT in the office brings in new clients for
cosmetic care who then can be referred to the
podiatrist when they need medical foot care. The
podiatrist becomes "my podiatrist" in their mind,
even before they need them - the MNT is trained to
create this mindset and it works!

n summary, the law has not changed. The podiatrist
must perform the care (RFC) on an ill patient in
treatment and no, they cannot bill an MNTs
services to insurance or Medicare, The services by
MNTs are considered cosmetic, though their license
does include RFC as per the definition of that
care. Also, in every state I know of, the room the
MNT works in must be licensed as a salon, though
it still is a fully equipped podiatry room for use
when the MNT is not present. This is a simple
process to complete and does not change the room
(or practice) in any way. Yes, there are nuances
in adding an MNT but clarification does come easy.


Janet McCormick, MS, Nailcare Academy, LLC,
Naples, FL

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