Making the use of DME and the Medicare Therapeutic Shoe Program easier.
Customer LoginMedicare 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.
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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.
More than 75% of patients with diabetes and Medicare fit with shoes one year are not fit the next. This, despite annual coverage that offers podiatrists very reasonable reimbursement and that the American Diabetes Association recommends that patients be evaluated annually to determine their level of ulcerative risk.
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 exam as well as qualifications for shoes under the Therapeutic Shoe Program.
The brochure is available personalized with your practice name and address. Use as both an appointment reminder for patients’ CDFE and to explain to patients its importance. It includes at-home foot care tips. It also shows a preview of stylish athletic, dress or casual Medicare-covered diabetic shoes.
Call 866.712.STEP (7837) to order free sample brochures. Also schedule a FREE Training Session with a SafeStep EXPERT to learn how to ensure that patients with diabetes, fit with shoes are, if qualified, fit year after year. Let us show you how to ensure that patients in need of care get it and also that your practice does not miss out on revenue opportunities.
At the conclusion of your training session, your SafeStep EXPERT will ensure that you:
SafeStep DME Training will help you grow your practice, improve patient care and enhance practice revenue.
Schedule a FREE Training Session with a SafeStep EXPERT to learn how to ensure that patients with diabetes, fit with shoes are, if qualified, fit year after year. While Medicare offers coverage for replacement shoes each calendar year, in most practices, less than ¼ of patients fit one year are fit the next. Let us show you how to ensure that patients in need of care get it and also that your practice does not miss out on revenue opportunities.
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 fitting diabetic shoes an important part of your practice. In one 45-minute session, you will cover:
At the conclusion of your training session, your SafeStep EXPERT will ensure that you:
SafeStep DME Training will help you grow your practice, improve patient care and enhance practice revenue cialis generique fiable.
Question: Does the 2% payment reduction under sequestration apply to the payment rates reflected in Medicare fee-for-service fee schedules or does it only apply to the final payment amounts?
Answer: Payment adjustments required under sequestration are applied to all claims after determining the Medicare payment including application of the current fee schedule, coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. All fee schedules, Pricers, etc., are unchanged by sequestration; it’s only the final payment amount that is reduced.
Question: How is the 2% payment reduction under sequestration identified on the electronic remittance advice (ERA) and the standard paper remittance (SPR)?
Answer: Claim adjustment reason code (CARC) 223 is used to report the sequestration reduction on the ERA and SPR.
The Budget Control Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt action to address the current budget uncertainty and the economic hardships imposed by sequestration.
This listserv message is directed at the Medicare FFS program (i.e., Part A and Part B). In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.
The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.
Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the 2 percent reduction. The Centers for Medicare & Medicaid Services encourages Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare’s reimbursement.
Questions about reimbursement should be directed to your Medicare claims administration contractor. As indicated above, we are hopeful that Congress will take action to eliminate the mandatory payment reductions.
The National Government Services, Jurisdiction B Medical Review department recently conducted a widespread post pay probe for HCPCS codes A5500, A5501, A5512, and A5513. A widespread post pay probe is a selection of paid claims reviewed for medical necessity based on a particular service from multiple suppliers. The suppliers who had claims selected and reviewed for this probe have been sent final probe determination letters. The letter indicates the probe review findings and any overpayment(s) identified. The claims that were found to have been paid in error have been adjusted and a demand letter has been generated.
The following are the most common errors found during the recent medical review audit of therapeutic shoes and inserts and clarification of documentation requirements.
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Long-term use of shoe orthoses significantly reduced diabetes-related amputations, according to study results recently presented at the International Society for Prosthetics and Orthotics World Congress in Hyderabad, India.
Researchers studied 114 Swedish patients with diabetes and a risk of developing foot ulcers. Over 2 years, patients wore one of three different types of shoe orthoses.
Results showed that the use of orthoses, podiatry, education and regular check-ups helped patients avoid foot ulcers. Overall, only 0.9% of participants developed new foot ulcers during the first year vs. an industry average of 3% to 8% reported in similar diabetic populations.
By 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.
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Amputations caused by diabetic complications can be reduced by at least 50%with the use of proper shoe inserts, podiatry care and regular health checkups, according to a study that will be presented at the International Society for Prosthetics and Orthotics World Congress in Hyderabad, India from Feb. 4-7.
The study, conducted by researchers at the University of Gothenburg’s Sahlgrenska Academy in Gothenburg, Sweden, included 114 patients with diabetes who were at risk for developing ulcers. Each participant wore one of three shoe insoles and was monitored over a 2-year period. The researchers found that only 0 cialis pas cher france.9% of the participants developed a new ulcer during the first year.
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