Sunday, November 27, 2022

Responses diabetic rules

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 about 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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