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MIPS DRIVES SUCCESS BY PROMOTING FALL RISK ASSESSMENT, FITTING SHOES, ORTHOSES & AFOS

Failure to submit Medicare MIPS quality measures will cost physicians tens of thousands of dollars. In 2018, podiatrists have to submit quality measures all year and not for just a 3-month window, like in 2017. Also, the penalty for not submitting increased to 5% of Medicare payments. However, podiatrists should appreciate that performing MIPS measures may also allow billing for office visits and will increase awareness of when balance AFOs, payable by Medicare, should be prescribed.

DON’T BE HIT WITH MIPS PENALTIES: DOWNLOAD THE LATEST MIPS FALL RISK ASSESSMENT TOOL HERE

MIPS quality measures 154, falls risk assessment and 155, falls, plan of care, address falls being the leading cause of injuries for older adults. One in four Americans aged 65 and over falls each year. By identifying people with gait instability, podiatrists can reduce this risk and make fall prevention a valuable part of their practice.

Physicians should annually, ask every patient, 65 and over, whether they have fallen in the past year. If so, they should follow-up by asking how many times and if the patient suffered an injury. Patients who have fallen two or more times or once with injury are defined to be at high risk.

These patients should be evaluated using a fall risk assessment form available from SafeStep.
Gait, strength and balance are assessed by having patients perform a “Timed Up and Go Test”. Patients stand, walk 10 feet, turn around and sit down. If TUG takes more than 12 seconds, there’s a good chance such conditions as: muscle weakness, difficulty walking or unsteadiness on feet are present.

MIPS 154 also requires assessing another contributing factor to falling including:
• a review of medications, or
• asking if the patient has had an eye exam in the past year, or
• reviewing other possibly contributing medical conditions, or
• determining the presence of postural hypotension.

Patients should be provided with a Plan of Care that includes balance, strength and gait training instructions, advice about vitamin D and information about home fall hazards. To make it easy, when using the assessment form available from SafeStep, simply tear off and give the patient a sheet that’s part of it.

When patients have NOT fallen two or more times or once with injury, submit MIPS quality measure 154 using CPT code 1101F.

If patients at high risk for falls are evaluated and provided a plan of care, consider billing E&M code 99213. Also submit codes 3288F and 1100F for MIPS 154 and 0518F for MIPS 155.
When there is fall risk, based on gait assessment, consider prescriptions for balance footwear, foot orthotics and possibly balance AFOs.

SafeStep has available, for free, copies of a Fall Risk Assessment form that assists in satisfying the MIPS fall prevention requirements. Medicare compliance documentation for AFOs can be best assured by using SafeStep’s WorryFree DME program.

Medicare DME Reimbursement Increases in 2018

Good news!
On January 1, 2018, Medicare increased the amount it pays for diabetic shoes, Moore Balance Brace and Arizona custom AFOs.

While the amounts paid may vary slightly by state, the National Fee Schedule is as follows:
Depth Shoes (A5500): pair $143.12
Prefabricated, Heat Molded Inserts (A5512): pair $58.38
Custom Molded Inserts (A5513): pair $87.12
Depth Shoes w/3 pr. Prefab, Heat Molded Inserts: $318.26
Depth Shoes w/3 pr. Custom Molded Inserts: $404.48
Custom Molded Shoes w/offset heels and rocker bottoms: $570.38
Arizona AFO, Standard (L1940, L2330, L2820): each – Ceiling $1178.61 Floor $883.96
Moore Balance Brace (L1940, L2330, L2820): pair – Ceiling $2357.22 Floor $1767.92

For a complete listing of updated DME allowables, including prefabricated and custom ankle-foot orthoses, visit:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule-Items/DME18-A.html?DLPage=1&DLEntries=10&DLSort=2&DLSortDir=descending

MIPS DRIVES SUCCESS BY PROMOTING CDFE AND SHOE FITTING IN 2018

Failure to submit Medicare MIPS quality measures will cost physicians tens of thousands of dollars. In 2018, podiatrists have to submit qualify measures all year and not for just a 3-month window, like in 2017. Also, the penalty for not submitting increases to 5% of Medicare payments. However, podiatrists should appreciate that performing MIPS measures may also allow billing for office visits and will increase awareness of when shoes and inserts, payable by Medicare, should be prescribed.

MIPS quality measures 126 and 127, diabetic foot exam including evaluation of footwear, address the association of neuropathy with diabetic foot ulceration. Properly fit shoes have been demonstrated to significantly reduce the likelihood of foot ulceration in patients with diabetes. By identifying people who qualify for shoes paid for by Medicare, podiatrists can make shoe fitting a valuable part of their practice.
Podiatrists should annually perform an ulcerative risk assessment on every patient with diabetes. A CDFE should include testing for loss of protective threshold using a 10-gram monofilament plus at least one of the following neurological exams including feeling vibration using a tuning fork, pinprick sensation, or ankle reflexes. Testing should also look for vascular, dermatological and structural findings. The foot should be sized using a standard measuring device, and the patient counseled on appropriate footwear based on risk categorization.

Patients with Medicare and diabetes who are identified to be at increased risk for ulceration should be fit with shoes and inserts. Shoe fitting will be most successful when patients are recommended models based on the consideration of what’s referred to as the 4 S’s of shoe fitting: Size, Shape, Stability & Style.

When patients with diabetes are given a comprehensive diabetic foot exam and provided a plan of care, which may include prescribing shoes, consider billing E&M code 99213. Also, submit codes G8404 for MIPS 126 and G8410 for MIPS 127.

SafeStep has available, for free, copies of a CDFE form that assists in satisfying the MIPS diabetic foot examination requirements. Medicare compliance documentation for diabetic shoe-fitting can be best assured by using SafeStep’s WorryFree DME program.

To access SafeSTep training and webinars, visit:

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