1. Dia-Foot Medicare Compliance Program MAKING IT EASY FOR YOUR PRACTICE TO RENDER THE DIABETIC SHOE PROGRAM

2. Dia-Foot’s Medicare Compliance Program  Fax clinical foot exam  Fax patient’s PCP (or Endocrinologist) information  Fax shoe order form  Fax number is 888-dia-foot  If ordering custom inserts put custom insert form and shoe order form in the foam box. Please check off the box on the shoe order form that you are participating in our Medicare compliance program.

3. Medicare Compliance Program- Clinical Foot Exam Guidelines.  No templates  No check off boxes  Must have detailed written order for 1 pair of diabetic shoes and 3 pairs of diabetic inserts.  If ordering custom inserts must mention how you measured for them and the justification for ordering custom inserts.  Must have justification for ordering diabetic shoes and inserts in exam note  Must have measurements of the both feet in size and width.  Make the note clear and concise so the auditors can easily read and understand them.  We will fax back note if does not meet the above guidelines.

4. Medicare Compliance Program  Our insurance staff will get the clinical foot exam signed, dated and agreed upon by the patient’s PCP or Endocrinologist  Our insurance staff will get the certifying statement signed and dated by the patient’s PCP or Endocrinologist  Our insurance staff will get the last medical note from the patient’s PCP or Endocrinologist. This note must be within 6 months of the patient receiving their shoes. This note must be signed by the Physician and NOT the NP or PA.

5. Medicare Compliance Program  Once we receive the documents we will check them to make sure they are accurate.  We will put the documents in a sealed envelope  Your shoe order will be shipped with the sealed envelope. Make sure the shoes match up to the invoice in the box prior to making an appointment for the patient.  If customs were ordered one pair will be in the shoes. 2 other pairs along with the original manufacturers inserts will be in a bag.

6. Medicare Compliance Program- Delivery of Shoes  Dispense the shoes and have patient sign Proof of Delivery form which also contains break in period, warranty and instructions.  In office dispensing note must be written saying the shoes and inserts fit well. If pre-fab inserts were dispensed how they were molded to the foot.  Bill Medicare for A5500 Right 1 unit and A5500 Left 1 unit with KX modifier  Also Bill A5512/A5513 Right 3 units and A5512/A5513 Left 3 units