Therapeutic Shoe Program

Slides:



Advertisements
Similar presentations
Diabetes and Your Feet A Brief Overview Dr. John Kadukammakal, DPM, AACFAS.
Advertisements

Diabetic Therapeutic Shoes Rules. Pre-Payment Audits The ability to perform a pre-payment review is part of the DMAC rules Is this a problem for.
Canadian Diabetes Association Clinical Practice Guidelines Foot Care
Coding for Medical Necessity
2 Agenda Goals of documentation training Iowa Administrative Code SURS Reviews Questions & answers.
Podiatrists How can we help? Sue McAusland Podiatrist Blackpool Teaching Hospital NS Foundation Trust.
Medicare Quality Improvement Organization (QIO) Reviews Under the Benefits Improvement and Protection Act §521 Presented by Alabama Quality Assurance Foundation.
Ideal Footwear for diabetics Presented by, Dr.J.L.Shah Physician & diabetologist Sonal Hospital & diabetes clinic, Lalgate, Khandbazar, Surat.
Foot problems are an important cause of morbidity in diabetes mellitus. vascular and neurologic disease contribute to this problem.
Documentation The Centers for Medicare and Medicaid Services (CMS) have specific documentation necessary prior to dispensing diabetic footwear. The Therapeutic.
Small steps to healthy feet
Diabetic Foot An Overview Foot team Prof.Mamdouh El Nahas Prof.Hanan Gawish Dr. Manal Tarshoby Dr.Omnia State Prof.Mamdouh El Nahas. Hanan Gawish Dr Manal.
Offloading the High Risk Foot Strategies for Reduction of Plantar and Peripheral Pressure Areas for Treatment and Prevention of Skin Breakdown.
Slides current until 2008 Diabetic neuropathy Wound healing.
Every 30 seconds a lower limb is lost somewhere in the world as a consequence of Diabetes. The Lancet Volume 366 Issue 9498.
Utilization Review Update Durham Center Access February 23, 2011.
2009 AOPA Assembly Top Ten Presentation Modifiers.
Chapters Recently Changed.  Medicare Benefit Policy Manual  Chapter 1 - Inpatient Hospital Services  Covered Under Part A  1 – Definition of Inpatient.
Prepared by. As stewards of a chapter’s money the chapter officers are responsible for the careful handling and dissemination of funds.
Adjustment & COCP Barbara Kwok Licensing Operations Specialist.
Slides current until 2008 Diabetic neuropathy. Curriculum Module III-7C Slide 2 of 37 Slides current until 2008 Diabetic foot disease – the high-risk.
DIABETIC FOOT CARE BAGIAN ILMU KEDOKTERAN FISIK DAN REHABILITASI RS DR. HASAN SADIKIN BANDUNG.
Presented by Josh White, DPM, CPed
INTEGRATED CARE MANAGEMENT AND QUALITY IMPROVEMENT South Carolina KePRO QIO Request Submission Requirements New 6/14/2012.
Funding Wheelchairs: Does your doctor know what documentation is required? David Kreutz, PT, ATP.
Podiatry and the treatment of Rheumatoid Arthritis
The Centers for Medicare and Medicaid Services (CMS) have specific documentation necessary prior to dispensing diabetic footwear. HIPAA Patient File CMS.
Foot care Diabetes Outreach (June 2011). 2 Foot care Learning objectives >To understand peripheral vascular disease (PVD) >To understand neuropathy (nerve.
Lower Extremity and Foot Assessment and Risk Determination
Intervensi Ortotik Prostetik Pada Diabetik Foot IOPI Konferense Solo 2010 Markku Ripatti.
Understanding Your Paycheck and Tax Forms
Understanding Medicare Billing Issues
1 The Dentist’s Legal Responsibilities to the Patient Dental Law and Ethics.
October 2009 Presented by EDS Provider Field Consultants Home Health Billing and Common Denials.
Small Enough to Give the Personal Touch Diversified Evaluation Network, Inc. Toll Free: (888) Fax: (248) Independent Medical Evaluation.
Integrating the Resident into Private Practice Wendy Beattie, CPO.
Face-to-Face Encounter Final Rule Guidance for Preparation NHPCO November 2010 © NHPCO 2010.
1 “It doesn't get any better!” "…Our patients are completely satisfied with the excellent choices that Orthofeet presents. Returns are almost zero, and.
Challenging Patient: Older Patient with Multiple Co-Morbidities.
Pure Stride Over the Counter Orthotics
MO-260 Medical Office Applications
Offloading Device for the Reduction of Foot Complications in Diabetic Patients Michael Osborne Michael Osborne Rod Aliabadi Rod Aliabadi Patrick Gonzales.
MidAtlantic Vascular, LLC Critical Limb Ischemia. P.A.D. Detection, Treatment, and Referral Paul Sasser MD FACS.
Diabetic foot Thongchai Pratipanawatr MD.. Site of Diabetic foot ulcers Site% Toe51 Plantar metatatarsal and mid foot 28 Dorsum of foot14 Multiple ulcers7.
Shaun White 307 High Street T: F:
Fitting Feet Without Problems  Re-measure feet each time buying shoes  Choose a quality athletic or walking shoe  Ideal heel—¾-inch or less  Outer.
Dia-Foot Medicare Compliance Program MAKING IT EASY FOR YOUR PRACTICE TO RENDER THE DIABETIC SHOE PROGRAM.
How to Fit Therapeutic Shoes Fitting your patient with their diabetic inserts and shoes is an important part of the diabetic preventive care your providing.
Offloading Device for the Reduction of Foot Complications in Diabetic Patients Michael Osborne Michael Osborne Rod Aliabadi Rod Aliabadi Patrick Gonzales.
AOPA TOP TEN SERIES Top Ten Myths in O&P Billing 2009 AOPA National Assembly Seattle, Washington.
___________________ Foot Pathology Trainer’s Guide
Blue Cross and Blue Shield of Nebraska is an Independent Licensee of the Blue Cross and Blue Shield Association. Timely Filing and Corrected Claims October.
MEDICAID NURSE AIDE ORIENTATION Mason Co. ATC Mary Beth Riggins R.N.
Foot Health John Shapiro, DPM Instructor Department of Orthopaedics University of Maryland School of Medicine 9/15/2010.
PATIENT & FAMILY RIGHTS AT DOHMS. Fully understand and practice all your rights. You will receive a written copy of these rights from the Reception, Registration.
Office of the Medicaid Inspector General Home Health and Personal Care Audit Protocols James R. Kaiser
Not So Golden Years: Foot Care & Safety for Older Adults.
The Diabetic Foot Thomas LeBeau, DPM FACCAS
No such thing as Routine Foot Care
Medicare Changes April 08, 2011 WSOPP Presented by: Chris Duprey
The Peer Review Higher Weighted Diagnosis-Related Groups
Diabetic Shoes/Inserts
Face to Face (F2F) Documentation Changes for Physicians
Face to Face (F2F) Documentation Changes for Physicians
CARRIER ADVISORY COMMITTEE REPORT 2011
Technical Assistance Webinar
Chapter 3: Basics of Health Insurance
Therapeutic Shoe Program
Matilde Monteiro-Soares Anne Rasmussen Anita Raspovic Isabel Sacco
Presentation transcript:

Therapeutic Shoe Program

Diabetic Shoe 2015 Fee Schedule Shoes with Pre-Fab Inserts A5500-$70.57 1 Right and 1 Left A5512-$28.79 3 Right and 3 Left Total allowable $313.88

Diabetic Shoe 2015 Fee Schedule Shoes with Custom Diabetic Inserts A5500-$70.57 1 Right and 1 Left A5513-$42.96 3 Right and 3 Left Total allowable is $398.90 Average profit is $228

Diabetic Shoe 2015 Fee Schedule A5501 Custom Shoe includes one pair of custom inserts $206.49 right and left A5503-A5507 Shoe modifications. $33.54. This code replaces one set of inserts when used. L5000 Toe Fill

Therapeutic Shoe Program

Coverage Criteria 1. Patient has diabetes mellitus 249.00-250.93 2. Patient has one or more of the following conditions documented by the certifying physician: a. Previous amputation b. History of previous ulceration c. History of pre-ulcerative callous d. Peripheral neuropathy with evidence of callus formation of either foot e. Foot deformity f. Poor circulation in either foot

Coverage Criteria 3. Signed certifying statement from physician (not a nurse practitioner) certifying that criteria 1 and 2 are met and patient is being managed for their diabetes. Patient must have had in-person office visit with their physician within 6 months prior to delivery of shoes/inserts and signed statement after visit and within 3 months prior to delivery of shoes and inserts

Coverage Criteria (3) 4. Prior to patient selecting items, supplier must conduct and document in-person evaluation 5. At time of delivery supplier must conduct and document in-person visit with patient

Requirements for Depth Shoes-A5500 Full length, heel-to toe filler which provides a minimum of 3/16” of additional depth Made from leather or suitable material Has shoe closure Available in full and half sizes with a minimum of 3 widths. Custom Shoe (A5501) is constructed over a positive mold.

Prefabricated Insert-A5512 Total contact Multiple density Prefabricated Heat moldable PDAC approved

Custom Fabricated Insert-A5513 Total contact Multiple density Has to be PDAC approved Document why you chose custom inserts Missing toes or partial foot amputation inserts code L5000.

Allowance per Calendar year One pair of depth shoes (A5500) and 3 pairs of insert (A5512 or A5513) Modifications may be covered as a substitute for an insert A5503-Rigid Rocker Bottom, Roller Bottoms A5504-Wedges A5505-Metatarsal bars A5506-Offset Heels A5507 Other modification

Custom Molded Shoes A5501 right and left Patient must have a deformity that cannot be accommodated by a depth shoe Must be well documented in suppliers records Can bill for 2 additional pair of A5512 or A5513 per calendar year.

Separate Inserts May be covered and dispensed independently of diabetic shoes if: Supplier documents patients has appropriate footwear for the inserts Footwear has to meet PDAC guidelines for depth shoes.

Certifying Physician Prior to signing certification statement Certifying physician must: Personally document in medical record one or more of the criteria a-f OR -Obtain, initial/sign, date and indicate agreement with medical records of a DPM, other MD, DO, PA, NP or CNS that documents one of more of criteria are met

Prescribing Physician Writes the order for shoes and inserts Knowledgeable in fitting May be: Podiatrist, MD or DO, PA, NP or CNS May also be the supplier

Supplier Person that furnishes the shoes and inserts Bills Medicare May be: -Podiatrist -Pedorthist -Orthotist -Prosthetist - Other qualified Individual Prescribing physician may be the supplier

Modifiers LT=Left Side and RT=Right side Must be used for shoes and inserts When a pair is provided on same DOS bill 2 units for shoes and 6 units for inserts Use KX modifier when requirements have been met and GY when not met EY=no heath care provider order for this item. Claim will be denied as shoes need an order

Documentation Detailed written order needed each year Beneficiary’s name Physician Name Date of order Detailed description of the item(s) Physician signature and date Written order can be in your detailed clinical examination

Sample clinical exam Date of Exam: Patient Name:   Subjective: Patient returns the office for a diabetic foot exam and diabetic therapeutic shoes and inserts. Objective: Dystrophic discolored nails 1-5 bilateral. Nails have subungual debris and do not cause discomfort due to neuropathy. Posterior Tibial pulse 1/4 bilateral. Dorsalis Pedis Pulse 1/4 bilateral. Capillary filling time of hallux prolonged (4 seconds) bilateral and diminished hair growth of legs. Using a Semmes-Weinstein 5.07 monofilament nylon wire, sharp and dull sensation was decreased on both feet. Vibratory sense was decreased at first MPJ using a tuning fork. Pes Planus and second metatarsal plantarflexed with asymptomatic callus. Decreased fat pad and hammertoes 2,3,4 bilateral. Using a Branock device, feet measured heel to toe size 10, heel to ball, size 9.5 and width, wide. Assessment: Peripheral neuropathy and peripheral vascular disease secondary to type 2 diabetes. Plantarflexed second metatarsal head causing hyperkeratosis with risk of ulceration if not off-loaded appropriately. Mycotic nails 1-5 bilateral. Plan: Debrided mycotic nails 1-5 bilateral. Debrided hyperkeratosis (grade 0 ulcer) sub second metatarsal bilateral. No underlying infection noted. Ordered therapeutic diabetic shoes (New Balance 813 white, 10D). Took foam impression for custom diabetic inserts to off-load second metatarsal head bilateral with aperture and metatarsal pad to reduce the risk of plantar ulceration. Prefabricated inserts would not provide enough protection for my patient. The patient will receive the shoes when all paperwork is filled out by her PCP. Return to office 9 weeks for continued diabetic foot care. Dr. Jones agrees with this exam and that the patient qualifies for a pair of diabetic shoes and inserts. Joe Smith, DPM Date signed__________________ Seth Jones, MD Date signed____________________

Documentation Signed statement from certifying physician specifying the patient: Has diabetes Has a condition defined in coverage criteria Being treated under comprehensive plan of care for diabetes Need diabetic shoes

Documentation In-person evaluation at time of selections must document: Examination of patient’s feet Measurements of patient’s feet in size and width How the foot was molded for custom inserts if ordered.

Documentation In-person evaluation at time of delivery with patient wearing shoes and inserts documenting proper fit. This medical record will be required in an audit as shoes and inserts have to be custom fit.

SAMPLE DELIVERY PROGRESS NOTE (For Shoes and Custom Diabetic Inserts)   Patient returns to office for pick up of diabetic shoes and inserts. Patient was fitted with New Balance WW813WT size 10D and custom inserts. The inserts matched the sole of the foot and the aperture and metatarsal pads were correctly placed to off-load the second metatarsal head bilateral. The custom inserts fit well within the shoes. The patient was fitted with both the inserts and shoes and there were no areas of excess pressure noted, nor when the patient ambulated down the hallway. The heel fit snug and there was ample room in the toe box. The patient found both the shoes and custom inserts comfortable and supportive. Appropriate paperwork was signed today by the patient including the warranty form and proof of delivery form. Patient to return for their diabetic routine foot care appointment and instructed to inspect the sides and bottom of their feet in the evening to ensure there is no skin irritation from the inserts or shoes. Patient told to call the office immediately if any problems or questions arise concerning her shoes, inserts and feet in general. SAMPLE DELIVERY PROGRESS NOTE (For Shoes and Prefabricated Diabetic Inserts) Patient returns to office for pick up of diabetic shoes and inserts. Patient was fitted with New Balance WW813WT size 10D and prefabricated diabetic inserts. The inserts were heated with a heat gun (or an oven) and the inserts were molded to the foot in a semi-weightbearing manner (patient sitting in a chair). The inserts were placed on a foam cushion and I placed both feet on the inserts and had the patient place mild weight on the inserts while holding the foot in a neutral position with heel close to vertical to provide a more supportive arch. The inserts were removed after they have cooled and held their shape and the exact same procedure was done to the next two pairs.

Proof of Delivery Supplier Standard 12 Required to verify beneficiary received DME item you are billing for. Must be available upon request Maintain document for 7 years Most important document in your chart.

Contents of Proof of Delivery Patient’s name Quantity delivered Detailed description of item delivered Brand name and serial number Date of signature must be date beneficiary or designee received item Date of service = date of delivery

Beneficiary Authorization Beneficiary must authorize supplier to bill Medicare Sign and date item 12 on the CMS-1500 claim form or Signature on File One time authorization Statement from beneficiary authorizing Medicare benefits to be paid to themselves or the supplier

Recapping Clinical Exam for the DPM Note in exam why the patient qualifies for the shoes Write an order for the shoes Document the measurements of the patient’s feet in size and width If ordering custom inserts document how you molded for them and why the patient needs them. Have an area on the exam for the patient’s MD to sign, date and agree with your exam

Recapping Documentation for the DPM 2. Fax your medical note and certifying statement to PCP to get signed and dated. Have a fax cover sheet explaining what you need done and why. Also request the last medical record for the patient to documents the PCP is managing the patient’s diabetes. 3. When these 3 items are faxed back the shoes and inserts can be dispensed.

Recapping documentation for the DPM 4. Dispense the shoes and write a note on fitting and instructions. Have patient sign proof of delivery form. 5. Have patient sign a beneficiary authorization form, instructions, warranty form and return policy form. 6. Bill CGS using appropriate KX, LT and RT modifiers along with correct amount of units.

WIN-WIN-WIN Protect your patient’s feet Save Medicare Money by reducing complications from diabetes Increase office revenue