GOVERNMENTAFFAIRS
This progress note stated that the dorsalis pedis & posterior
tibial pulses were faintly palpable bilaterally. Capillary refill
time was within 2 seconds to all digits. Temperature, tone and
turgor were within normal limits. Hair growth was noted and
symmetrical. The doctor also noted mild, non-pitting ankle
edema. Neurological status revealed diminished protective
sensation from the ankles down. Cavus foot structure was also
noted bilaterally as well as hammertoe deformity of digits 2-5.
This note was signed by R.B., DPM and co-signed by S.M.,
MD on 08/09/2012. Under S.M.’s signature there was a
notation that this was the signature of the Certifying Physician
to “indicate agreement with above findings.”
Other Supplier Records: The file includes a “Shoe Fitting
Form” dated 08/06/2012. This form listed heel to toe, heel
to ball and midpoint measurements as well as foot width and
any deformities the fitter observed. Additionally this form
documented the name, color, size and width of the shoe the
beneficiary chose.
The supplier’s file also included a form titled, “Chart Notes of
Dispense”. The note was signed by R.B., DPM on 09/05/12.
The note described the process of molding the inserts and
said, after molding, there was total contact between the plantar
surface of the patient’s foot and the inlay. The note stated that
proper use and care of the shoes and inserts were reviewed with
the beneficiary. Also that the, “Pt. indicates that the shoe and
inserts are comfortable.”
the date of service listed on the claim. The beneficiary must
therefore approve any changes to the quantity delivered, item(s)
delivered or date delivered. Consequently, if an incorrect
signature date was entered on the delivery slip, the supplier
should have requested that the beneficiary initial and date the
correction.
Additionally while the certifying physician, Dr. S.M., co-signed
the foot exam performed by Dr. R.B. (Podiatrist) and signed
the statement of certifying physician, there were no medical
records directly from him to verify that, within six months prior
to delivery of the shoes, he saw the beneficiary and conducted a
face-to-face exam for the purpose of managing the beneficiary’s
systemic diabetes condition.
Medicare will accept a co-signed podiatrist’s assessment from
the certifying physician for the qualifying foot condition;
however, we must additionally have medical records from
the certifying physician regarding the beneficiary’s diabetes
management.
If your referring physicians have questions regarding
documentation requirements for therapeutic shoes for persons
with diabetes, provide them with a copy of the therapeutic
shoe “Dear Physician” letter available, along with additional
documentation resources on PFA’s website at www.pedorthics.
org in the “Information for DMEPOS Suppliers” section.
Medical Review Decision – Deny the claim
The delivery slip serves to verify that the beneficiary is
accepting delivery for the items that the supplier is billing for
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