Home Forums Discussions General Discussion Diabetic Shoes

Medicaid in my state has decided that every pair of diabetic shoes has to be prior auth and a copy of the relevant progress note sent to the vendor.

They say this is because this is what Medicare will as us to do starting January 1.

I love taking care of my Medicaid pts (really), but resent having to spend staff time to do busy work that will make money for a retailer.

I am considering starting to sell Diabetic Shoes. Does anyone have experience with this aspect of a practice?

A quick search revealed the following requirements:

Medicare program carriers generally require the following before reimbursement will be made for shoes, inserts or modifications furnished to a program beneficiary.
A certification of medical necessity from the physician who manages the patient's diabetes, which certifies that the patient:
(a) has diabetes mellitus,
(b) has at least one of the qualifying conditions,
(c) is being treated under a comprehensive plan of care for his or her diabetes, and
(d) needs diabetic shoes.

Medicare carriers recommend that suppliers use the Medicare approved ?Statement of Certifying Physician for Therapeutic Shoes? form to fulfill this requirement.

A prescription for a particular type of footwear (e.g., shoes, inserts, modifications) from a podiatrist, or physician who is knowledgeable in the fitting of diabetic shoes and inserts. Suppliers are required to keep file copies of signed and dated physician prescriptions.

The footwear must be fitted and furnished by a podiatrist or other qualified individual, such as a pedorthist, orthotist, or prosthetist. The certifying physician may not furnish the footwear unless he or she practices in a defined rural area or health professional shortage area. Only then, the prescribing physician may be the supplier.

Another option is to consider that you bring the patient in specifically to review their diabetes, evaluate need for shoes and inserts - write the scrip, generate the chart note, etc. - This at least generates you a fairly high level office visit.

I think you have to register as a DME provider. I think they have to bill differently and have different hoops to jump through. It may be more hassle than it's worth.

Others here may have more information

Another site says the following:

Does Medicare Cover Diabetic Shoes?
Yes, Medicare will cover the cost of one pair of therapeutic shoes (diabetic shoes) and inserts for people with diabetes if you have a medical need for them. The Medicare payment for therapeutic shoes is subject to the requirement that they are necessary and reasonable for protection of insensitive feet or neuropathy (nerve damage in the feet). To ensure that Medicare pays for your shoes, you must follow the steps below:

Your treating doctor must complete a certificate of medical necessity for the therapeutic shoes and document the need in your medical records. So, do not order anything until you have visited your doctor - no matter what the sales person tells you.
The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist.
The supplier must receive the order before Medicare is billed and must keep it on file.
If you receive your Medicare through a Medicare Advantage Plan (like a HMO, PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of diabetic shoes.


******* My concern with the above is that many pharmacies provide these shoes (with minimal training by the shoe provider) and I am not clear if this really meets the requirement.

Thanks for your responses. There was an article in the most recent Medical Economics talking about how many more hours we are all spending doing the busy work associated with patient care. I do make patients come in whenever I fill out any forms. I go at such a pace and work such long hours, I just cannot fill out forms outside of a visit. Esp with FMLA and other forms, I have found it helps to have the patient there. That way I understand exactly what they need and they know exactly what I am going to put in the form.

I am definitely in a HPSA area and rural so I may be able to do the shoes. Will have to look into it more. For many of my indigent patients, this is the only pair of shoes they get each year. I have so many diabetics with complications, I often end up cutting down callouses and debriding ulcers. The shoes often help.

I seem to get forms from the podiatrists to sign. I am going to check to find out why. It seems that they should be able to sign off on the forms. If they can, I may send them all to the podiatrist.

I'm going to look into this further. There must be some money in it because there are a lot of vendors in my area. I always steer the patients away from the mail order companies.

Thanks again for the input

A podiatrist can recommend and dispense shoes, but a MD or DO who manages their diabetes must fill out the certifying form for Medicare (to make sure someone is actually monitoring and treating diabetes). I think you should see who a podiatrist recommends fitting and dispensing the shoes (I think they use a trained orthotist or they do it themselves)- then you can have patients come in for a comprehensive diabetes exam, review, labs, etc and do the form.

Hi
I am a podiatrist. We are required to notify the patients M.D that we find the pt has some of the following, neuropathy,poor circulation ,hx of amputation, corns and callus. All of which predispose pts to amputation, charcot foot ect. Medicare wants confirmation from the MD that the patient is under the care of the md and has DM.
Most of us have sample shoes and oder on line for the patient. This makes it easier for the pt and makes us some money
Art

Nothing to do with the shoes but....

The barrage of newer paperwork is overwhelming my staff at times without an extra penny of reimbursement (actually drops in reimbursement). If I do an operation, they are in a 90 day global so no extra payment by bringing them into the office.

I wish the paperwork was standardized with each company but it's not. FMLA paperwork in itself is extraordinarily time consuming. It often has to be filled out, then possibly filled out again if the patient isn't quite ready to go back to work, then that brings about short term disability paperwork. And forget workmen's comp...it's a ton of paperwork including long-term disability paperwork. And cancer policies...I see a fair amount of those. And patients expect me to fill it all out as if it's included in the $33 payment from Medicare.

It's been suggested that patient's pay $10-20 for each time this has to be filled out. A reasonable idea but its tough to get Medicaid/Medicare patients to ever come up with money.

That's my rant.

Hi Art,
Can you order the shoes yourself without the MD sig? I work closely with one of the local podiatrists. He sends me a form to fill out and sign the order for the shoes. A good friend, Pharm D/CDE has been doing a lot of my patient's shoes. She's wonderful. It's just getting so expensive and frustrating to: 1. send the order to her with a copy of the progress note, 2. fill out sign and make a copy of her form that she sends back. After that, if the pt is Medicaid only, as I discussed above, she says Medicaid says I have to do the PA on the shoes that she will make money on. By the time I lose money on the pt encounter and all the busy work that goes along with it.

I will be calling Medicaid tomorrow and then on to CMS. I think the only way I can do this is to be involved in the sale of the shoes. I don't want to have to stop taking Medicaid.

I'm afraid you're right Wendell. We'll find out.

Travis, I feel your pain. The majority of the patients are wonderful folks with sad stories who are lucky to have Medicaid and/or Medicare.

If we were allowed to charge for time spent do our work the way attorneys and accountants do. Well, we can always dream.

Have a good week.