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Schedule a FREE Training Session with a SafeStep DME EXPERT to learn how with WorryFree DME, Medicare documentation when fitting diabetic shoes need no longer be a concern.
SafeStep Training Sessions are designed to help your practice grow. Schedule a FREE one-on-one personalized on-line appointment with one of our trained EXPERTS to make fitting diabetic shoes an important part of your practice. In one 45-minute session, you will cover:
- The essentials of shoe fitting
- How to perform the comprehensive diabetic foot exam
- How to benchmark the number of patients in practice who should be fit with therapeutic shoes
- Establishing office protocol to ensure that patients with diabetes are scheduled for annual risk assessment
- The role of the shoe fitter
- The essentials of Medicare DME compliance
- The benefits of outsourcing procurement of Medicare required compliance documentation
At the conclusion of your training session, your DME EXPERT will ensure that you:
- Determine your “Number”, the number of patients in your practice with Medicare and diabetes.
- Your office is set up for shoe fitting success
- Can track your practice shoe fitting success using the SafeStep Practice Report Card
- Determine if it would be beneficial to utilize free electronic billing to Medicare
- Know where more assistance is available.
- Schedule a follow-up appointment for additional training.
- Earn your PQRS incentive bonus from Medicare
SafeStep DME Training is intended to help you grow your practice, improve patient care and enhance practice revenue.
Call 866.712.7837 or email us at email@example.com to schedule your FREE individualized on-line session!
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Let Us Teach You
As with any intricate piece of equipment with many moving parts, the human foot is subject to a wide array of possible malfunctions—ranging from congenital deformity and improper gait to partial foot amputation—as the result of trauma or systemic disease such as diabetes. Whatever the cause, the result is pain and reduced locomotion.
Pedorthists and podiatrists are both trained to help patients overcome foot pain. As physicians, podiatrists can diagnose medical conditions in the entire lower limb and perform appropriate interventions. As professionals trained in the biomechanics of the foot and ankle, pedorthists understand how to build shoes and appliances that alleviate symptoms and correct foot and ankle pathologies.
Podiatrists routinely write prescriptions for footwear and devices that pedorthists are ideally qualified to provide; however, more and more allied healthcare professionals from outside the field are seeing the benefit of getting a foot in the door, so to speak. Physical therapists, chiropractors, and even athletic trainers can now provide prefabricated devices to help relieve foot pain, creating more competition—and confusion—in an already competitive field. The challenge for the pedorthic profession is to develop a more symbiotic relationship with podiatrists so that the two can work together seamlessly to provide optimal outcomes for patients in need of foot care.
Podiatrists have traditionally provided referrals to their patients who need therapeutic footwear. However, the opportunity to increase practice revenue, patient desire for “one-stop shopping,” and growing awareness of the Medicare Therapeutic Shoe Program have resulted in podiatrists increasingly making shoe fitting a part of their practices. As podiatrists become more efficient and skilled at fitting shoes and recognize how much they can benefit their patients while improving their bottom line, this trend is expected to continue.
Podiatrists can work most efficiently by creating “practice protocols” whereby commonly seen conditions are directed to and addressed in a routine way by trained office staff. Such an approach lends itself well to fitting patients who have diabetes and are at risk for ulceration with therapeutic footwear. Even before these patients meet with the podiatrist, offices can identify them and provide them with a brochure or information packet that details the role footwear can play in reducing their risk.
Our healthcare system is on a path that is economically unsustainable. One of the greatest challenges to providing broad-based, affordable healthcare coverage is the huge cost associated with diabetic foot disease. The significant costs of treating ulceration, infection and amputation are to rise significantly, based on the increasing incidence of diabetes ands demographic changes.
It’s been demonstrated that a multi-pronged approach to diabetic preventative foot care can effectively reduce the likelihood of foot disease and its associated costs. Podiatrists are well-positioned to implement frequent examinations, direct patient self-care and provide of properly fitting footwear.
Medicare has created programs that support such an approach and offer podiatrists a way to significantly improve practice revenue. The implementation of effective practice protocols is the key to reducing patients’ likelihood of ulceration, and reducing the costs to Medicare while increasing podiatrists’ earnings. A concerted commitment on the part of physicians and patients holds the promise of mutual benefit.
1) Determine the number of patients in practice who have diabetes (250.xx diagnosis).
2) Provide patient educational materials to raise awareness of diabetic preventative foot care.
3) Educate referring physicians about Medicare’s Therapeutic Shoe Program, requirements for their signature and return of Statement of Certifying Physician and report of Comprehensive Diabetic Foot Exam.
4) Determine staffing requirements for scheduling all patients with diabetes for Comprehensive Diabetic Foot Exams. Hire and train additional help as needed.
5) Provide established patients with diabetes information about the importance of the Comprehensive Diabetic Foot Exam and schedule an appointment separate from the routine foot care.
6) Perform CDFE, satisfying requirements for PQRS measures 126,127 and 163. Submit to Medicare using procedure codes G8404, G8410, and 2028F. Consider billing for CDFE as 99213 to satisfy requirements for items covered and time spent. For further explanation of CDFE, see article by Kenneth Malkin, DPM, “A Guide to Review of Systems”, www.docstoc.com/docs/3419459/AGuide-to-the-Review-of-Systems-Kenneth-F-Malkin.
7) At CDFE visit, if patient meets Medicare requirements for therapeutic footwear, select a size and style based on the patient’s risk categorization and aesthetic considerations. Shoe fitting is best accomplished by having the patient try on shoes from a fitting inventory. Patients who cannot be satisfactorily fit in depth shoes must be fit with custom-molded shoes. Podiatrists may cast and order these themselves or alternatively refer patients to an outside facility.
8) Write prescription for therapeutic shoes and accommodative inserts.
9) Use service to send to the Certifying Physician a copy of the Statement of the Certifying Physician AND the report of findings from CDFE. It is required to obtain from the Certifying Physician signed copies of both documents. Podiatrists as physician/suppliers are permitted to send findings of CDFE with diagnoses to the certifying physician to satisfy requirements that the MD / DO have documented in their own chart the condition(s) that qualify the patient for footwear.
10) Schedule patient to return for fitting of shoes and therapeutic inserts
after required compliance documentation has been received from the certifying physician. At the time of shoe fitting, pre-fabricated inserts are heat-molded to the shape of the patient’s feet, and the patient is advised of supplier standards, break-in instructions, and warranty information. The patient signs a certificate of receipt. Shoe fitting may be refined by the addition or removal of sizing spacers.
12) Provide patient education and emphasize the importance of daily patient foot examination.
13) Schedule the patient for a follow-up visit.
The good news is that practices fitting shoes are on average fitting more shoes each year. The average number of pair fit increased from 37 per year in 2008 to 54 in 2010. Despite this growth, a high percentage of at risk patients fit with shoes one year are not fit the subsequent year.
It would be unusual for patients who qualify for shoes one year to not qualify again. The therapeutic shoe program is designed to replace worn shoes and inserts each calendar year. From one year to the next, a percentage of patients move, die or elect to obtain care from a different foot care provider. Still, the majority of patients in a practice one year, are believed to remain in the same practice the subsequent year. If 100 patients are fit with shoes one year, it is estimated that approximately 75 should be fit with a replacement pair the following year.
While expected that 75% of patients fit with shoes one year should be fit the next, data obtained from a review of 2000 diabetic patients indicates that the actual “repeat rate” is less than 25%. “Repeat Rate” is referred to as the percentage of patients fit with shoes one year who by the end of the next calendar year are fit with a new pair shoes. This low rate of refitting patients on an annual basis is consistent over several years. In other words, when patients are fit with shoes one year, they are unlikely to be fit with shoes again. This unfortunate pattern is resulting in less than optimal care of patients, significant loss of practice revenue and Medicare having to pay for a lot of diabetic foot care that is preventable.
Let’s examine why offices are refitting on average only one of every four patients originally fit with therapeutic shoes and present solutions how to improve:
Issue: Difficultly accommodating all the patients with diabetes and Medicare in the practice. There are on average 316 patients with diabetes and Medicare in every podiatry practice. Most offices have unfortunately not created protocols to ensure that every patient with diabetes is evaluated on an annual basis and when indicated, fit for shoes. Consequently, patients are commonly seen every 61 days for “routine care” but not afforded the opportunity for more thorough risk assessment nor refitting for shoes.
- Schedule all patients with diabetes for annual ulcerative risk assessment and allow time for shoe fitting when indicated. Scheduling a separate, dedicated visit will allow sufficient time to discuss with patients the importance of footwear, daily self examination and the selection of appropriate shoe size and styles.
- Assign personnel, under DPM supervision, to perform bulk of CDFE and therapeutic shoe fitting.
Issue: Lack of training to effectively fit and recommend shoes taking into consideration size, shape, need for stability and available styles.
- Shoe fitting is not rocket science but there are most right and wrong ways to perform. The shoe fitter should recommend two or three styles and not allow patients a choice based solely on personal preference. Training is available online, at professional meetings at through manufacturer sponsored Therapeutic Shoe Fitter courses
Issue: Lack of shoe samples reflecting models most popular for practice.
- Display shoe samples of styles most popular for particular region.
- Discard sample shoes that have been discontinued or prove unpopular.
- Stay abreast of new styles offered.
- Display a range of manufacturers to reflect models
Issue: Failure of DPM to monitor establish targeted number of shoes to fit based on number of patients in practice with diabetes and who have Medicare as primary payer.
- “If you can’t measure it you can’t measure it”. Its possible to predict at the beginning of each approximately how many patients should be fit by the end of the year.
Issue: Failure to incentivize shoe fitter and patient scheduler if achieve targets for number of patients evaluated and fit.
- Many practices track the number of shoes fit and relates to employee compensation.
Issue: Failure to outsource document procurement so as to reduce workload on office staff as well as to ensure Medicare compliance.
- Use WorryFree DME to more efficiently and less expensively perform the routine task of compliance documentation procurement.
- Staff time can be better spent fitting shoes and not faxing.
Issue: Failure of DPM to monitor on a year-to-year basis which patients have received shoes and to ensure that they are evaluated to determine need to be fit each subsequent year.
- Shoes are covered on a calendar basis. If patients are tracked, they will be more likely to be scheduled for evaluation and fitting.
|Jones, Robert||3/12/10||Missed refitting||Missed refitting|
|Wishborne, Carol||–||5/9/11||Missed refitting|
|Greenberg, Edward||–||2/23/11||Missed refitting|
|Davidson, John||11/18/10||Missed refitting||Missed refitting|
|Smith, Fredrick||5/30/10||Missed refitting||Missed refitting|
Issue: Failure to implement patient recall program to contact patients fit with shoes in years past and not fit in current calendar year.
- Offices would benefit by sending reminder notifications to patients fit one year if they are not been fit by second half of subsequent year. It’s important to allow sufficient time to obtain required documentation.