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
> 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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