STANDARDS,
SPECIFIC DETAILS
& JEOPARDY
Specified footwear standardization for buyers grew out of
need. Buyers have to account for their purchases. Prescription
products must be of known quality. Think about how you are
affected as a supplier. Like it or not Medicare is a major factor
in your life. Many of you routinely lace audits for your billings to Medicare and secondarily to other health care system
providers. Industry wide your-products are judged by the use
of Medicare coding. Medicare coding has set the standard for
evaluating durable medical equipment. This is where specificity in standardization becomes crucial. Billing audits are
now a fact of life. How can audits be based on non-specific
standards and coding?
On what authority are Medicare therapeutic foot wear audits
based. Partly by the authority of the some very non-specific
directives such as: Medicare Local Coverage Article for
THERAPEUTIC SHOES for Persons with Diabetes - Policy
Article - Effective July 2010 (437076). see the link below:
As you read 437076 you will
see how little certainty is in
the directive. Keep in mind
that you are held accountable according to this
coding and you are
expected to be in
compliance.
The Medicare “Local coverage Article for THERAPEUTIC
SHOES for persons with Diabetes - Policy Article – Effective
July 2010 (437076)” provides the definition of how you will
responsibly fill a prescription for therapeutic footwear. Article
A37076 defines the billing coding and product expectations
for diabetic footwear products. Question any included code.
As you read 437076 you will see how little certainty is in the
directive. Keep in mind that you are held accountable according to this coding and you are expected to be in compliance.
For example, from the “CODING GUIDELINES” depth
shoe (45500) is one that:
1) Has a full length, heel-to-toe filler that when removed provides a minimum of 3/16” of additional depth
used to accommodate custom-molded or customized
inserts; and
2) ls made from leather or other suitable material of
equal quality; and
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Pedorthic Footcare Association www.pedorthics.org
Photos from: @Shutterstock.com/Robert Przybysz
"Article: Therapeutic Shoes for Persons with Diabetes"