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RE: Pre-Payment Audits for Therapeutic Shoes

This is a letter that was sent to along with Josh’s response:

Having just read that 90%** of post-payment audits show fraud (mistakes do not occur when any provider bills for a service: Contact your local RAC auditor) and 93%** of pre-payment audits reveal the same, I was relieved to post the following message in my waiting room:

“We no longer participate, endorse, recommend or prescribe MediCare Diabetic Shoes.”

In my opinion, a physician who participates in ANY aspect of the CMS Diabetic Shoe Progam needs to re-evaluate the level of risk-taking. There exists an overwhelming probability that they may not only be repaying large amount of monies back to CMS, but they may be soon finding their reputations and their very licenses under attack. It is very, very clear that the CMS’s ultimate goal is to make every physician a criminal.

Response from Josh

Medicare’s revisions to the Therapeutic Shoe Program speak to a desire to improve quality of care and work very effectively to DPMs’ advantage. I think that the main reason why over 90% of suppliers failed post-payment audits for therapeutic shoe claims is that they did not completely understand Medicare documentation requirements nor how to efficiently comply. Fortunately compliance need not be onerous using a program developed by SafeStep called “WorryFree DME”. By streamlining documentation procurement and guaranteeing Medicare compliance, fitting diabetic shoes should be seen as very worthwhile.

An explanation of each of the six required pieces of documentation and how each might be easily obtained using the “WorryFree DME” program, should provide a comfort level that speaks to the foolishness of rejecting participation in the Medicare program. SafeStep offers free training webinars on Medicare compliance and the ease of using it’s WorryFree DME program. Click here to sign up:

Fear of audits resulted last year in a 20% decrease in the the number of shoes paid for by Medicare while the number of people on Medicare increased by 10%. In 20 years, the number of people with Medicare and diabetes is expected to QUADRUPLE. In my experience, the reason why most podiatrists are not fitting nearly as many shoes as they have the potential to is failure to have good protocols in place and responsibilities assigned to capable, enthusiastic people in the practice. There should be someone to ensure that every patient who has diabetes is evaluated to determine if they qualify for shoes, is fit when appropriate and is rechecked on an annual basis. While such an approach requires some work and a change in the way most offices operate, I suggest that the $200 or more profit possible from fitting each pair of shoes should comfortably offset whatever additional cost is needed to ensure such a program’s success.

Given such programs as PQRS and the Therapeutic Shoe Program, CMS is making it very, very clear that it’s ultimate goal is not to make every physician a criminal but to promote a team approach to comprehensive, cost effective, preventative care.

Josh White, DPM, CPed
President / Founder, SafeStep