As reflected in the 2012 Podiatry Management Practice Management survey that approximately one third of podiatrists fitting shoes have stopped, it’s clearly been a challenging past few years. A host of issues have contributed to many not utilizing the Medicare shoe program. Some of the most common and how each can be addressed are listed below:
Issue: Fear of Medicare audits based on lack of understanding of compliance requirements.
Solution:
- While there is the perception that there have been widespread Medicare audits, according to Podiatry Management’s 2012 survey, the percentage of podiatrists audited by Medicare dropped from 5.2% in 2011 to 3% in 2012. Paul Kesselman, DPM, reports in Podiatry Management that while durable medical equipment suppliers have initially failed more than 90% of audits, most commonly for lack of appropriate compliance documentation, upon appeal, more than 90% of DPMs have had favorable outcomes resulting in claims being paid.
Issue: Difficulty complying with revised Medicare documentation requirements
Solutions:
- The supplier fitting footwear must perform an examination that directs the style of shoe most appropriate for patients’ pathology. This can be easily addressed by performing an annual comprehensive diabetic foot evaluation (CDFE) on every patient with diabetes.
- CMS requires that physicians managing patients’ diabetes be aware of the specific predisposing foot pathology. This can be best accomplished by podiatrists sending certifying physician the significant findings of the CDFE.
- Patient must been seen by certifying physician no more than 6 months prior to receiving shoes. Shoes must be fit no more than 3 months after the Certifying Statement is completed by the MD / DO. The podiatrist must be certain to fit shoes before these deadlines are passed.
Issue: Difficulty understanding new enrollment requirements and encountering NPI crosswalk error.
Solutions:
- DME suppliers are required to “link” their Medicare NSC # (DME supplier number) to their NPIID (National Plan Identifier). Linkage can be ensured by going to the NPPES website, https://nppes.cms.hhs.gov/NPPES/Welcome.do.
Issue: Tri-annual $505 Medicare registration fee
Solutions:
- This new fee, payable every three years, is well worth paying given the allowable reimbursement for DME products.
Issue: Failure to renew Medicare DME enrollment as required every 3 years.
Solution:
- Medicare sends DME suppliers a letter requesting updated information every 3 years. If not responded to within 30 days, Medicare will inactivate the PTAN supplier number, requiring the DPM to reenroll, a process that can take several months and prevents payment for claims submitted during that time.
Issue: Feeling overburdened by implementation of electronic medical records.
Solution:
- For many practices, the opportunity to receive incentive bonus for implementation of EMR has been top priority, has required tremendous effort and has superseded many other desires. Now that most offices have made the transition, the opportunity exists to focus back on shoe fitting.
Issue: Lack of cooperation from certifying physicians who are required to sign and date compliance documentation
Solution:
- Some MDs have felt burdened by frequent requests for their certification of qualifying risk factors. Combined with a lack of understanding of the Medicare program, some have been resistant to comply with their Medicare requirement and made it difficult for their patients to receive shoes. Generally the situation can be improved if better communication is initiated by the referring DPM. Ideally physicians managing diabetes should refer all patients to DPMs to be evaluated and fit for shoes when indicated.