Current Pedorthics January-February 2017 | Vol.49, Issue 1 - Page 23

" We made the decision that we will not dispense shoes until we have notes in hand that will back up the RX and DWO ."
You might as well make up your mind that you will get negative feedback from the clinics . You had also better make up your mind that it is okay and that it is a part of your job to help them get it right if you want to get paid . But if you are persistent you usually will get what you need . I have found that I have good success by calling and speaking with the nurse . They will usually write down exactly what you need and see to it that the doctor makes the needed changes .
So , what happens if you can ’ t get the doctor to give you good notes ? It is quite simple — you contact the patient and let them know that Medicare will not pay for their shoes with the current exam notes . Offer them the opportunity to purchase them over the counter . Very few will take you up on this but you still should try . Often , they will tell you they will contact the doctor ’ s office about the problem . I have received many phone calls from clinics that previously had said they would not make changes to exam notes asking me what Medicare requires after having been confronted by their patient . Although this is a last resort , I have found it to be very effective when needed .
It is easier to pass audits and get paid for Medicare shoes than many people suspect . Overall , Medicare is very clear on what they require . Sure , there are some gray areas , but most of your patients are going to fall into the parts of the code that are black and white . If you will get a plan of action similar to the one adopted at our DME you will find that your passing grades on audits will go up . You won ’ t pass them all , but you ’ ll make it most of the time . Medicare has targeted diabetic shoes as an area for high audits due to many claims that lack sufficient documentation . So , adopt a plan that will help you get what they want and your reimbursements should increase .
PFA
Current Pedorthics January / February 2017 21