Making the use of DME and the Medicare Therapeutic Shoe Program easier.

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Helpful Links Using the Medicare DME Portals

Each of the DME MACs have created webpages that offer podiatrists and other DME suppliers access to useful Medicare information.  The “Portals” requires individual registration and uses a personal log-in.  They offer different levels of accessibility and also protects patient personal health information.  Presently Jurisdictions A and D are serviced by Noridian; Jurisdictions B and C are serviced by CGS.

Podiatrists are encouraged to register for the Portals corresponding to the region(s) where their patients reside and to also create access for appropriate staff members.  Some of the things that are certain to prove useful include: Medicare Beneficiary Identifier (MBI) lookup,  info about the Interactive Voice Response (IVR) for checking status of claims, and redetermination.

 

Noridian Medicare Portal (NMP)

Jurisdiction A, Jurisdiction D.

https://www.noridianmedicareportal.com/web/nmp/home

CGS Medicare Portal (myCGS)

Jurisdiction B, Jurisdiction C. 

https://www.cgsmedicare.com/jc/mycgs/pdf/mycgs_registrationguide.pdf

 

Medicare Beneficiary Identifier (MBI) Look Up Tool

A new Medicare Beneficiary Identifier (MBI) replaced the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status.

In the past, the HICN was based on a person’s social security number.  Every person with Medicare has been assigned an MBI and has been mailed a new Medicare card.  The MBI is confidential like the SSN and should be protected as Personally Identifiable Information.  The biggest reason for the new MBI is to fight medical identity theft for people with Medicare.

The MBI provides podiatrists and other DME suppliers information need to enter using the telephone key pad when using the IVR and is based only on the information you enter. 

Use this tool to convert the patient’s MBI to the corresponding numbers on your telephone key pad. 

https://cgsmedicare.com/medicare_dynamic/jb/mbiconverter.aspThe Medicare Beneficiary Identifier (MBI) Lookup Tool is an option for providers/suppliers if they are not able to obtain the MBI from the patient.

Noridian DME: Jurisdiction A, D

https://med.noridianmedicare.com/web/jadme%20/topics/nmp/end-user-manual/mbi-lookup-tool

CGS: Jurisdiction B, C

https://cgsmedicare.com/parta/pubs/news/2018/05/cope7584.html

 

Medicare Interactive Voice Response (IVR)

The Centers for Medicare & Medicaid Services (CMS) requires providers to utilize the Interactive Voice Response (IVR) System to check the status of claims.  The Interactive Voice Response (IVR) system requires you to enter your patient’s name and Medicare number during the beneficiary validation process.   The IVR will validate the beneficiary information.

 

Noridian: Jurisdictions A, D

https://med.noridianmedicare.com/web/jeb/contact/ivr

CGS: Jurisdictions B, C

To use the IVR, please call: 877.299.7900

 

Submitting Redeterminations Through the Medicare Portal

When AFO claims are denied and given reason code “M3”, it’s because of “Same or similar”, meaning that Medicare is only covering one device, prefabricated or custom, per side, every five years.  Claims to treat a different diagnosis with a different device, can generally be covered, even after initial denial, if appealed as a “Redetermination”.  Redetermination can be done either by faxing in a form and supporting documentation or via the Portal.  Its recommended that suppliers use the Portal, and not fax, as it provides assurance that all forms are received.  

 

Noridian: Jurisdictions A, D

https://www.noridianmedicareportal.com/

CGS: Jurisdictions B, C

https://cgsmedicare.com/articles/cope25316.html

 

Documentation Identification Tool

CGS has created the Documentation Identification Tool to assist you in submitting the different types of documentation needed to support your claim. Simply select the type of documentation you are submitting from our list of items below. Then print the pre-designed divider sheet and place it in front of the document(s) that will be submitted for review.

The documentation identification tool standardizes the process so you no longer need to create your own divider sheets for your documentation.

https://www.cgsmedicare.com/jc/help/documentation_identification_tool.html

 

Jurisdiction A is serviced by Noridian Healthcare Solutions   and includes Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.

Jurisdiction B is serviced by CGS   and includes Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.

Jurisdiction C is serviced by CGS   and includes Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virginia, West Virginia and the US Virgin Islands.

Jurisdiction D is serviced by Noridian Healthcare Solutions   and includes Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington and Wyoming,

 

AFO Custom Diabetic Insert Alert

 

Medicare is now differentiating between custom diabetic inserts fabricated by direct milling and those made by custom molding. Medicare requires that custom diabetic inserts made by CAD / CAM direct milling be billed using new code A5514 when dispensed, replacing K0903, effective January 1, 2019. Inserts provided by SafeStep are made in this way. If SafeStep does your billing, everything will be taken care of for you. If you submit claims yourself or via a billing service, be sure to start using the new custom insert code, A5514.

Both methods of manufacturing result in equivalent final products; reimbursement is also the same, $89.12 per pair, $267.36 for three pairs. Medicare is requiring manufacturers to submit custom diabetic inserts to PDAC for verification and has communicated that custom inserts need not be listed on the PDAC website, dmepdac.com.

If you have any questions, concerns or suggestions, please call our office at 866.712.STEP.

 

Essentials For Diabetic Shoe Fitting Success By Josh White, DPM, CPed

I recently visited a team a podiatrist’s office. They have been a part of the Therapeutic Shoe Program and fitting diabetic patients with shoes for many years. I appreciated their interested in learning how they could improve what could be considered a “good” shoe program, and in going from “good” to “better” or even “great.”

All staff members were encouraged to attend, including: the front office person, who is the eyes and ears of the practice, and who reminds the doctors which patients have diabetes and are due for an annual comprehensive diabetic foot exam (CDFE); the fitting person, who measures, fits and laces patients’ shoes – critical to the program’s success.

We reviewed how the Medicare Therapeutic Shoe Program provides win – win – win benefits for all: patients benefit by getting shoes they need for little or no cost, by doing so, they also decrease their risk for ulceration and amputation, and the office makes money while improving patient satisfaction (and Medicare actually reduces costs).

We reiterated the importance of clearly defining each step in the evaluation and shoe fitting process, and confirmed that while there could be more than one person performing each task, there must be a single person responsible for its execution.

And lastly, we defined the metrics for determining the success of each step – as well as for the program overall.

Here are the steps and how to determine successful execution:

  • Determine the number of patients in the practice with Medicare and diabetes. Every patient should have a dedicated visit for an annual comprehensive diabetic foot evaluation (CDFE) scheduled on a separate visit. This visit can performed by or overseen by the DPM and billed as 99213 if a predisposing condition of ulcerative risk is determined and a plan of care prescribed. Printed copies of the CDFE form are available, for free, from SafeStep upon request. Here is a link to the form: http://safestep.net/safestep/PDF/CDFE(Interactive).pdf?id=431. Note: Someone should track the number of CDFE exams performed (on an ongoing basis), and compare it to the number of patients with diabetes in the practice.
  •  Conservatively, 75% of patients with Medicare and diabetes will have a qualifying risk factor and should be prescribed therapeutic shoes. When scheduling patients, either have a shoe fitting person in the practice available to assist on that day or consider OHI’s Central Casting Program, an on-site Pedorthic service availing Certified Pedorthist to assist podiatrists with examining, casting and fitting patients.
  • Every shoe fitter and CPed should use the “4S’s approach to shoe fitting” which are: Size, Shape, Stability, Style to fit and pair the shoes that meet each patients’ aesthetic desires and therapeutic needs. It’s important to have shoe samples in the styles patients most prefer, and to update them periodically. Fitting displays or a small fitting inventory will go a long way to improve fitting success and patient satisfaction. Patients whose fitting needs exceed what’s possible with depth shoes should either be casted for custom molded shoes or referred to a local footwear clinic. The SafeStep website displays the practice’s “Fit Rate”. If not 85% or better, help is available to fit at least as well as is done by the average office.
  • Use SafeStep’s WorryFree DME program to create Medicare compliance documentation and to procure required authorization from the certifying MD physician. SafeStep’s team of professionals and dedicated services help you save time, and build your practice.
  • When dispensing shoes, emphasize to patients the importance of daily footcare and self-examination to check for signs of ulceration. Encourage them to wear their fitted shoes and inserts as a preventative measure, and to return on an annual basis to be re-evaluated for replacement shoes each year.
  • The true indicators of a successful diabetic shoe program is when the number of shoes fitted increases each year, and the number of wounds treated decreases. While some practices have been deterred from fitting shoes because of the effort required and concerns about Medicare audits, many enjoy the success that this preventative care indicative was intended to achieve. Read the article “Keys for Success for Fitting Diabetic Shoes” to learn more.
  • Qualifying patients should be scheduled for an evaluation and fitted with shoes annually. Despite the benefits, most practices refit less than 25% of patients from one year to the next when all it takes is an outreach effort to patients from each year. Your SafeStep homepage displays the practice “Repeat Rate”. There are tools available, including patient lists, which can be used to facilitate a recall program, to ensure that every patient is evaluated annually to be refit with replacement shoes. To better understand the true value to your practice, read “The $40,000, 4 Hour per Week Diabetic Shoe Program”. The article describes how little time is actually needed, if the program is organized effectively, to yield significant benefits to patients and to the practice.
  • Successful practices set goals at the beginning of each year and monitor their performance on an ongoing basis. To recap, key metrics for ensuring program success include:
    1. The number of annual CDFE’s performed on patients with Medicare. Compare to the number of patients with Medicare and diabetes in the practice. Every patient should have at least one annual evaluation.
    2. The number of shoe fit, covered by Medicare. Conservatively, 75% of patients with Medicare and diabetes will have a qualifying risk factor and should be fit with shoes.
    3. Shoe fit rate. Should be 85% or better. Track on SafeStep Members Home Page. If lower than it should be, assistance is available to help improve.
    4. Refit Rate: Should be 75% by end of year.

Successful practices create incentive programs to reward staff members responsible for each of these key metrics.

  • Further assistance is available by scheduling a One-on-One Training Session with a SafeStep DME Specialist. Topics include:
  • “The WorryFree DME Shoe Ordering Process”
  • Diagnosis Specific DME Treatment Protocols for AFOs
  • AFO and Shoe Compliance Documentation
  • 18 Surefire Ways to Improve Your Shoe Fitting
  • Fall Risk Management Made Easy with Moore Balance
  • The CDFE Strategy

I hope you find this article helpful. I truly enjoy writing these articles and working with practices to help them become more successful. Our friendly SafeStep customer service team is available to assist you with your account and all programs, products, services.

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.

2016 Patient Brochure Helps Ensure That Patients With Diabetes Get Evaluated For Annual Shoe Fitting

More than 75% of patients with diabetes that are fit with shoes covered by Medicare are only fit one year and not the next. Despite the American Diabetes Association recommending that patients be evaluated annually to determine their level of ulcerative risk, and the annual coverage that offers podiatrists very reasonable reimbursement, patients are still not receiving the attention they deserve. SafeStep has created a brochure for podiatrists to give to patients with Medicare and diabetes when scheduling an annual Comprehensive Diabetic Foot Exam.  The brochure explains to patients the importance of the annual exam as well as qualifications for shoes under the Therapeutic Shoe Program.

side-1safestep-cdfe-brochure-2016-side-2

New Billing Codes for Plantar Fascia Night Splints, Pneumatic and Non-pneumatic Walking Casts

Medicare now differentiates between off-the-shelf and custom fitted type prefabricated AFOs including pneumatic and non-pneumatic walkers and plantar fascia night splints.

Traditionally used codes reflect the custom fitted version and the allowable amounts for both are currently the same.  For devices traditionally billed using L4360, L4386 and L4396, new codes reflecting the off-the-shelf definition most likely apply.

Click below to read entire article:

NEW BILLING CODES FOR PLANTAR FASCIA NIGHT SPLINTS, 150127

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.

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!