Sunday, December 4, 2022

Re: Responses diabetic rules

Richard Feldman

Would someone please inform me as to why you cannot bill the patient
“private pay” using
the Advanced Beneficiary Notice of possible denial?
Is there any rule that says as a Medicare provider a O and P office must
take assignment on
this diabetic shoe service?
Am I alone in wanting to receive a reasonable and customary fee for saving a
patient from a
amputated toe, foot, ankle, or leg?
Please reply to this list. I would appreciate any factual reply.
Sincerely, rick/cpo

On Thu, Dec 30, 2010 at 5:23 AM, Rick wrote:

> ORIGINAL QUESTION:
> My office manager highlighted the new Medicare diabetic shoes rules in the
> December edition of the Almanac…
>
> One in particular bothers me:
> Effective Jan 1, 2011…the certifying physician must have an in-person
> visit with the patient during which diabetes management is addressed within
> 6months before delivery of the shoes and/or inserts. ….there must also be
> documentation of an in-person visit with the prescribing physician within
> 6months of delivery of the shoes and/or inserts.
>
> The bothersome part is WE are responsible to ensure that the patient’s
> prescribing physician documents abouou their diabetes & need for protective
> footwear…are we supposed to get copy of their Dr visit-notes?
>
> Good thing: Physician’s in our area will not sign an Rx or certifying forms
> unless they have seen the pt within 6months, but who’s to say the patient
> will follow through w/their Dr appt following receipt of shoes/inserts?
>
> I don’t love working with diabetic shoes/inserts, but I’d hate to leave
> diabetic footwear to the shoe stores that “specialize” in diabetic shoes.
> You know the ones…. they allow Tommy Highschooler who “loves running
> shoes” fit the diabetic shoes.
>
> Who’s dropping diabetic shoes/inserts from their scope of practice?
> If you are continuing to provided diabetic footwear, how are you going to
> ensure the physician’s documentation adequately covers what you’re doing?
>
> ************************************RESPONSES*************************************
> I asked a similar question on the List Server about documentation a few
> months ago. The simple answer is that the providing facility will need to
> obtain the physician’s records. Someone who recently attended a Medicare
> seminar told me that this advice was given directly from Medicare to
> providers. In order to ensure compliance, the facility will have to make
> obtaining the proper records a condition of seeing that patient for the
> physician. It puts a huge burden on the OP facility. We don’t provide
> diabetic shoes/inserts, and are even less likely to start now.
> CPO
> ****************************************
> well, we have modified CPSFTS by adding line “when was the last visit
> regarding therapeutic shoes:___________”
> will it work or not, we’re about to find out.
> *****************************
> I attended a Medicare meeting early in November in Madison Wi. and the
> reps from Medicare stressed that we have notes in our records from the Dr.
> if we used the KX modifier when we bill the shoes and inserts. They showed
> examples of how detailed the notes need to be. How much insulin is used, how
> often do they test, do they do any exercise, etc, any chart notes you can
> get is better than none. It appeared that they plan to do spot checks for
> compliance with this issue.
> I hope this is helpful to you.
> CP
> ************************************
> Plus you can not bill for the shoes until the pt has gone back to the MD so
> he/she can document proper fit. These new rules are ridiculous.
> Personally, if I provide a prosthesis, then the shoes are free. You can use
> an ABN (pt. needs to check option 2) plus we have developed a form for the
> pt. to sign that he/she does not want to use their Medicare benefit.
> CP
> *********************************
> We’ve discussed it as a company and the consensus is that the patient
> ultimately has to be responsible. We are sending each new patient a
> packet with a checklist of things they need to bring to us or allow us
> to acquire from their physician prior to evaluating them for new shoes.
> This will include having them bring the latest copies of their diabetic
> physician visit and signing off that they have met all the requirements,
> etc. If the patient wants coverage for their diabetic shoes, they should
> have to jump through the hoops that their insurance has placed on them
> just like an anthem patient is required to obtain a referral to see a
> specialist.
> Our office staff will be making sure the patient has brought all the
> materials needed and advising them of what they are missing etc but we
> will not proceed until they have met all the requirements.
> I have a feeling this will limit the amount of shoes we’re providing but
> so be it….most of the podiatrists are doing dr. comforts around us
> anyway. It will be interesting to see how they meet the new
> requirements….will they have to team up with local diabetic
> physicians?
> C.P.O.
> *********************************************
> If you have been checking your RX and the therapeutic letter you just need
> to check the dates. If the doctor is treating the patient for diabetes and
> his podiatrist writes the RX just be sure the dates are on them. This is
> not
> new only spelled out clearer than previously by Medicare. The real shame is
> that now we are being asked more often to be Medicare policemen.
> No title provided
> ************************************
> We are a small PandO company in eastern Virginia.
> As of January 2011 we are no longer doing diabetic shoes. Too much hassle
> not enough money. We will continue doing orthopedic shoes.
> Please forward any responses. thanks
> CPO
> *********************************
> You must make sure you have all documentation, forms, and notes PRIOR
> to delivering shoes and/or inserts or your claim will be denied and
> you will have wasted time and money.
>
> We get all of this before we even schedule the patient for their first
> visit. If the patient doesn’t get what they need and you have already
> had an appointment to pick out shoes you may have just wasted the
> practitioners valuable time. If they don’t do what they need, and you
> have not seen them, then no harm done to your practice.
>
> I agree with you…shoes are a necessary evil. No one like to do them
> and certainly no one likes the new rules but we do find it important
> to make the contact with the patient for future business and to make
> sure they get what they really need.
> LAT, COF
> ***************************
> Hi Rick, after over 30 years of doing shoes, we dropped shoes completely
> when Medicare required our facility to be accredited and we had to be
> bonded. These people that make the rules are out of control. Let the
> patients work things out with their Senators and Congressmen, then come see
> us. I even dropped my C-Ped.
> CPO
> **********************************
> Rick, amen on your post, we are printing certifying physician forms and
> forcing our Patients to see their physician and bringing them back signed-I
> can’t think of another way to insure our prescribing Physicians are in
> compliance. I have also heard we are to perform sensation evals and document
> that as well-can you believe this?
> CPO
> ***********************
>
> I feel bad for our diabetic pts, but it looks like we too are giving up on
> providing this service.
> Anyone interested in purchasing some Pedors 3P diabetic inserts??!
> THANK YOU ALL
> & HAPPY NEW YEAR!
> Rick
>
> Rick Milen, CPO, PTA
> NEXSTEP, Inc.
> Prosthetic Specialists
> West Lawn, PA
> www.iwalknexstep.com
>
>
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