REIMBURSEMENT & CODINGNEWS
c .
d .
e . ulceration of either foot , or
History of pre-ulcerative calluses of either foot , or
Peripheral neuropathy with evidence of callus formation of either foot , or
Foot deformity of either foot , or f . Poor circulation in either foot ;
In order to meet criterion 2 , the certifying physician must either :
vii .
Personally document one or more of criteria a – f in the medical record of an in-person visit within 6 months prior to delivery of the shoes / inserts and prior to or on the same day as signing the certification statement ; or
viii . Obtain , initial / sign , date ( prior to or on the same day as signing the certification statement ), and indicate agreement with information from the medical records of an in-person visit with a podiatrist , other M . D or D . O ., physician assistant , nurse practitioner , or clinical nurse specialist that is within 6 months prior to delivery of the shoes / inserts , and that documents one of more of criteria a – f .
Note : The certification statement is not sufficient to meet the requirement for documentation in the medical record .
There must be documentation to support that the certifying physician has certified that indications ( 1 ) and ( 2 ) are met and that he / she is treating the patient under a comprehensive plan of care for his / her diabetes and that the patient needs diabetic shoes . For claims with dates of service on or after 1 / 1 / 2011 , the certifying physician must :
• Have an in-person visit with the patient during which diabetes management is addressed within 6 months prior to delivery of the shoes / inserts ; and
• Sign the certification statement ( refer to the Documentation Requirements section of the related Local Coverage Determination ) on or after the date of the in-person visit and within 3 months prior to delivery of the shoes / inserts .
A large number of suppliers failed to respond to our request for records .
Suppliers are in violation of Supplier Standard # 28 when , upon request , they fail to provide requested documentation to a Medicare contractor . Medicare regulations ( 42 C . F . R § 424.516 [ f ]) stipulate that a supplier is required to maintain documentation for seven years from the date of service and , upon the request of CMS or a Medicare contractor , provide access to that documentation . Therefore , the consequences of failure to provide records may not only be a claim denial but also referral to the NSC .
There must be documentation to support that at the time of delivery of the items selected , the supplier must conduct and document an in-person visit with the patient . The in-person evaluation of the patient by the supplier at the time of delivery ( refer to related Policy Article , Non-Medical Necessity Coverage and Payment Rules , criterion 5 ) must be conducted with the patient wearing the shoes and inserts and must document that the shoes / inserts / modifications fit properly .
It is important for suppliers to be familiar with the documentation requirements and utilization parameters as outlined in the Therapeutic Shoes for Persons with Diabetes Local Coverage Determination ( LCD ) and Policy Article . Suppliers can also review the Therapeutic Shoes documentation checklist and other resources on PFA ’ s website .
INDUSTRY EVENTS CONTINUED continued from page 43
has presented some obstacles ,” says Pamela Haig , C . Ped ., Vice President and Founder of the Institute , “ we are working diligently to continue the legacy of pedorthic education in Indiana ! Our not-for-profit school is optimistic about the academic future for aspiring pedorthics in the upcoming decade .”
Haig also acknowledges that creating a firm foundation for knowledge - in a brick-and-mortar school for future generations is important . She also stresses that pedorthics is a viable healthcare profession and should have a facility solely devoted to pedorthic academics . Haig hopes the industry will continue to sponsor various educational programs throughout the USA .
With Powersteps generous donation , the first section of repairs has been completed on the dome . The next phase will incorporate four flags on the four corners of the second level , just below the dome . The Institute has already reserved a space for the American flag as well as a Powerstep flag as a token of their appreciation . There will also be the Elwood Flag or State of Indiana Flag donated by the city ’ s Mayor , and perhaps if allowed , a flag with PFA ’ s logo showing everyone who observes the dome the power of pedorthics .
46 Pedorthic Footcare Association www . pedorthics . org