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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.

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

Keys for Success: Fall Risk Prevention … It’s a Best Practice!

The SafeStep Keys for Success that you’ll see here are based on real examples from podiatrists and can dramatically improve your practice.

October Key for Success: Set Up a Fall Risk Prevention Program

On an annual basis, it is important to ask every patient 65 years of age and older, if they have fallen in past year. This is a baseline for a fall-risk assessment and is a precautionary measure to help more patients.

If patients have not fallen or have fallen once without injury, consider them to be NOT at high risk for falls.

If patients have fallen once and been injured or two or more times without injury, consider them to BE at high risk for falls and use SafeStep’s “Functional Fall Risk Assessment Tool” to determine the basis for increased risk.

If fall risk assessment determines the increased risk to be orthopedic in origin, perform a “Biomechanical Evaluation” to determine the specific etiology and guide a plan of care. Such a plan might include:

  • Offering assistive devices including canes and walkers for those at risk.
  • Providing patients guidance about footwear options that will enhance stability.
  • Consideration of foot orthoses that can decrease foot pain and improve support.
  • Providing physical/occupational therapy options.
  • When appropriate, casting for bilateral Moore Balance Braces.
  • Its appropriate to bill an EM charge when fall risk is determined and a plan of care provided.

In order to learn more about how to get started:

1.     Read articles in library section of SafeStep website.

2.     Register at SafeStep.net for the training webinar: “Fall Risk Management with Moore Balance”.

3.     Call for SafeStep at 866.712.STEP for patient information brochures, order forms, free mailing labels and STS casting kit.

4.     Review the semi-weightbearing casting technique. Video located in AZ AFO section of SafeStep website, Library section.

5.     The SafeStep website features all Medicare required compliance documentation.

Increased Medicare DME Reimbursement for 2015

Good news!! On January 1, 2015, the Medicare fee schedule for diabetic shoes, Moore Balance Brace and Arizona custom AFOs increased. While the amount reimbursed by each DME MAC may vary slightly, the National Fee Schedule allowables are as follows:

Depth Shoes (A5500) $141.14
Prefabricated, Heat Molded Inserts (A5512) $57.58
Custom Molded Inserts (A5513) $85.92

Depth Shoes w/ 3 pr. Prefab, Heat Molded Inserts $313.88
Depth Shoes w/ 3 pr. Custom Molded Inserts $398.90
Custom Molded Shoes w/ Custom Molded Inserts $586.42

Arizona AFO, Standard (L1940, L2330, L2820) $1162.23
Moore Balance Brace (L1940, L2330, L2820) $1162.23

For a complete listing of updated DME prices, including prefabricated and custom ankle foot orthoses, go to:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html.

Extra-depth Shoes May Help Alleviate Foot Pain for Older People

For adults over age 65 with disabling foot pain, being fitted for off-the-shelf extra-depth footwear reduced pain and improved function, according to a new study.

This type of footwear is often marketed to people with diabetic foot ailments, for whom Medicare – the U.S. government health insurance program for people over 65 – will cover most of the cost of the shoes.

Click here to read the full article!

Fall Risk Management & The Moore Balance Brace 4-Part Webinar Series!

Several of your patients with an appointment today are at risk for falls and one-third of them will fall without your professional intervention.

Dozens, perhaps hundreds, of your patients can benefit from a Fall Risk Management Protocol that includes the Moore Balance Brace (MBB).  By offering such a protocol to your at-risk patients, you’ll be preserving their quality of life and you may even save lives.  In the process, your practice will experience significant growth.  In other words, doing well by doing good.

Beginning October 14th, Josh White, DPM, C.Ped, will be hosting a series of free, live, interactive webinars that will provide a step-by-step guide to incorporating Fall Risk Managment into your practice.

The series will cover the following topics: (Click date to register)

Don’t miss out on this special series – see you at the webinar!

 

 

That Daily Shower Can Be a Killer

fall-in-showerBy JARED DIAMOND
Published: January 28, 2013 in the New York Times

The other morning, I escaped unscathed from a dangerous situation. No, an armed robber didn’t break into my house, nor did I find myself face to face with a mountain lion during my bird walk. What I survived was my daily shower.

You see, falls are a common cause of death in older people like me. (I’m 75.) Among my wife’s and my circle of close friends over the age of 70, one became crippled for life, one broke a shoulder and one broke a leg in falls on the sidewalk. One fell down the stairs, and another may not survive a recent fall.

Continue Reading on the New York Times website

 

Schedule a FREE Training Session with a SafeStep EXPERT

Schedule a FREE Training Session with a SafeStep EXPERT to Start up a Fall Prevention Program in your Practice

SafeStep Training Sessions are designed to help your practice grow.  Schedule a FREE one-on-one personalized on-line appointment with one of our trained EXPERTS to make fall prevention an important part of your practice.  In one 45-minute session, you will cover:

  • The scope of the problem
  • The role of the podiatrist in preventing falls
  • How to perform a fall risk assessment
  • How the Moore Balance Brace can help
  • Review of MBB models
  • Medicare compliance
  • Steps to integrate fall prevention into your practice

At the conclusion of your session, your EXPERT will:

  • Ensure that your office has patient brochures and posters
  • Order casting kit, casting socks, if needed.
  • Print fall risk assessment, order forms
  • Provide shipping labels.
  • Show where more assistance is available.
  • Schedule a follow-up appointment for additional training.

SafeStep EXPERT Training is intended to help you grow your practice, improve patient care and enhance practice revenue.

Call 866.712.7837 or email us at info@safestep.net to schedule your FREE individualized on-line session!

Register for a free Fall Prevention webinar

Order free Patient Brochures/Office Posters

Let Us Teach You

Falls are a BIG Problem; Become a Prevention Expert and Watch Your Practice Soar

Josh White, DPM, CPed

One out of three adults age 65 and older fall each year.  Falls are a silent killer that most podiatrists simply don’t think much about addressing.   Given the scale of the problem and the prevalence of risk factors, developing a specialty in fall prevention presents podiatrists with an opportunity that can significantly benefit their patients and their practice.

Conditions commonly seen by podiatrists and associated with increased risk for falling include:

  • Foot pain
  • Ankle weakness
  • Limited ankle motion
  • Postural instability
  • Loss of proprioception
  • Inappropriate shoe gear

Other risk factors podiatrists should be cognizant of include: dizziness, history of falls or near falls, peripheral neuropathy, impaired balance and drug interactions.  If any of these conditions are determined, a more comprehensive fall risk assessment is indicated.  See the sample podiatric fall risk evaluation form.

Balance and walking speed gradually decline with age.  This is attributable to decreased muscle mass and is exacerbated by reduced activity level. Weakening of the anterior tibialis muscle decreases the body’s ability to maintain balance and may affect the timing of toe clearance during the swing phase of gait.  Tripping can result from the toe catching on the floor.  Postural sway relates to the constant displacement and correction of the body’s center of gravity over it’s base of support.  Decreased muscle strength, particularly with decreased sensation can lead to increased postural sway and increase one’s risk for falling.

No assistive device is as effective at decreasing the likelihood of falls as a walker.  Patients though are often resistant to accepting such a device or a cane.  Unfortunately, the impetus to use a canes or walker often comes only after a fall occurs.   Ankle foot orthoses improve stability by reducing postural sway, increasing sensorimotor feedback and thus improving proprioception.   AFOs are only effective when worn and pose patient compliance issues relative to ease of use, impact on shoes that can be worn, comfort and appearance.  Fortunately, improved AFO designs fit more easily into shoes, are lightweight, offer ease of closure and still address risk factors that can contribute to increased risk for falling.

Medicare policy makes clear that patients documented to have orthopedic risk factors for falls are covered for custom AFO’s.  The Medicare LCD states that to be covered, an item must “be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member”.  The Medicare Benefit Policy Manual states that appliances are covered when “used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body.”  If biomechanical examination determines any of the following diagnoses to be present, clinical indications demonstrating medical necessity are met:

  • Muscle weakness (728.87)
  • Ataxia, muscular incoordination (781.3)
  • Gait abnormality/ staggering, ataxic (781.2)
  • Osteoarthritis, localized primary ankle & foot (715.17)
  • Arthropathy, unspecified, ankle and foot (716.97)
  • Pain in joint, ankle, foot (719.47)
  • Instability of joint, ankle & foot (718.87)
  • Dropfoot (736.79)
  • Hemiplegia (438.20)

Fall prevention requires a comprehensive approach to care of which custom AFOs may be one component.  Based on podiatric fall risk assessment, the podiatrist should consider prescription of primary and ancillary services.  Such services and conditions that each may address include:

Physical / Occupational Therapy :

  • history of falls
  • sensory deficits
  • muscle weakness
  • poor balance

Primary Care:

  • vestibular abnormalities
  • medication interactions
  • history of seizures
  • history of hypotension

Home Health Care

  • difficulty leaving the home
  • Muscle weakness
  • hearing loss
  • vision loss

By providing appropriate intervention, podiatrists can assume a leading role in a multidisciplinary approach to care.

Summary

There are some basic steps that podiatrists can take to develop a fall prevention program:

  1. Create awareness within ones’s practice regarding the risk of falls and that the office is committed to offering appropriate preventative care.  Consider informational brochures and office posters.
  2. Speak to community groups about the role of intervention to reduce patient risk.
  3. Network with other physicians and specialists including physical therapists, occupational therapists and home healthcare workers to promote a team approach to care.
  4. Perform fall risk assessment and consider use of balance AFO if appropriate risk factors are determined.

There is no simple fall prevention strategy that will work for all patients.  As falls result from of a complex interaction of intrinsic and extrinsic risk factors, interventions require a multi-faceted approach. A strong fall prevention strategy that encompasses a number of interventions and targets multiple risk factors is more likely to be successful.

Early Testing For Foot Orthoses Could Prove Beneficial to the Elderly

Research studies carried out among the elderly through the years have shown significantly more falls resulting in serious injuries, due to problems with balance.  Implementing balance testing and providing foot orthoses’s for elderly patients could prove to potentially decrease the amount of falls and injuries associative with them.

With the inclusion of specific balance testing such as the ‘tandem stance test,’ and the ‘tandem gait test’ specialists in orthopedic care can provide a better means of assisting their elderly patients with improving balance, thus minimizing serious bodily injury from falls.   Dr. Michael T. Gross said that, “clinicians should consider asking older patients about their balance, and have them perform simple one leg balance tests.”  This alone will help in determining specific balance problems, and earlier evaluations for the possible need of foot otrhoses’s, which could prevent accidental falls before they happen.  The varied participant studies have proven that foot orthoses’s which are designed for each individual patient’s needs work to improve their own balance defects.

While the studies have been small thus far, and the results “preliminary,” Dr. Gross says that, “It’s important to note that we examined and addressed individual foot issues.”  Therefore, these basic tests are detrimental in patient care, because they allow for individual structural differences in gait and balance for each patient’s orthoses design.  Not every patient needs corrective features, or something like arch support, and these basic tests can help determine what will provide the most improvement for each and every patient orthopedic specialists have come in.

To read the full article you can access it here:  http://www.lowerextremityreview.com/news/in-the-moment-footcare/enhancing-balance