billing diabetic shoes in nursing home.

billybrandle1964

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Does anyone know what the rules are and how to bill for diabetic shoes in Nursing home? Can we bill medicare for this or do we need arrange something for nursing home? how does this work> can anyone explain please!
 

twoerpel

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Brooklyn, WI
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It will depend on the patients Medicare stay status. Here is a link that may answer your further: https://apps.ngsmedicare.com/pdf/157_0709_DME Fact Sheet_DME in SNF_0310.pdf

the link states:

Medicare Coverage of Durable Medical Equipment While in a Skilled Nursing Facility


There are many situations where equipment or supplies that would normally be
submitted to the Medicare durable medical equipment (DME) contractor do not fall
under the DME claim jurisdiction when furnished to People with Medicare outside his
or her home. Certain items are covered for People with Medicare that are inpatient
in a skilled nursing facility (SNF). Determining which items can be covered depends
upon the status of the covered Medicare Part A stay.

The Medicare DME benefit will not consider coverage of DME such as, but not
limited to, wheelchairs, oxygen and oxygen equipment, hospital beds, walkers,
pressure reducing support devices, continuous passive motion devices, and negative
pressure wound therapy pumps while a patient is in a SNF because these items are
considered part of the SNF consolidated facility charges.

People with Medicare are eligible for 100 days of coverage as inpatient in a SNF per
benefit period. During this period, the only items that are covered separately by the
Medicare DME benefit are customized prosthetic devices.

After the 100 days of coverage has been exhausted, the DME benefit will consider
coverage on other items such as, but not limited to, the following equipment and
supplies while the patient is in a SNF:

n Ostomy supplies
n Urological supplies
n Surgical dressings—wound covers, gauze, wound fillers, and tape
n Immunosuppressive drugs
n Trach care kits
n Custom prosthetics
n Parenteral and enteral nutrition (PEN)
n Refractive lenses
n Dialysis supplies for residents selecting method 2
n Therapeutic shoes for patients with diabetes

Call 1-800-MEDICARE (1-800-633-4227)
Visit www.NGSMedicare.com –or– www.medicare.gov

I hope this helps to answer your questions.

Tami Woerpel CPC,CPMA
 

billybrandle1964

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Diabetic shoes in nursinghome

I get if there in the 100 days there skilled nursing facility. i was wondering if the podiatrist would have to be credentialed with that nursing home facility to be able to bill
 

jbmonroe

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Knoxville, TN
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Must be a supplier to bill shoes

Diabetic shoes have been a hot topic in the past few years as more and more suppliers are getting out of the business of providing them. If you are unfamiliar with billing diabetic shoes, it is unlikely you will be paid and most definitely will not pass the audits on them- the claims are audited frequently because the requirements are very stringent. THis link will help you get more familiar with the requirements.

https://www.cgsmedicare.com/jc/mr/PDF/Thera_Shoes_DC_int.pdf
https://med.noridianmedicare.com/do...ment.pdf/ee0e7ce1-8306-42ae-a587-03ca8db653d9


The most key piece here is that the patient's physician who manages their diabetes must see the patient, examine their feet and document the need for the shoes before writing the prescription. Podiatrists cannot prescribe diabetic shoes under Medicare guidelines:

I certify that all of the following statements are true:
1. This patient has diabetes mellitus.
2. This patient has one or more of the following conditions. (Circle all that apply):
a) History of partial or complete amputation of the foot
b) History of previous foot ulceration
c) History of pre-ulcerative callus
d) Peripheral neuropathy with evidence of callus formation
e) Foot deformity
f) Poor circulation
3. I am treating this patient under a comprehensive plan of care for his/her diabetes.
4. This patient needs special shoes (depth or custom-molded shoes) because of his/her diabetes.
 
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Cross, SC
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Orthotic and Prosthetic - Corporate Billing Administrator

A Podiatrist can prescribe diabetic shoes and inserts; however, the diabetes management must be documented by the physician that treats the patient's diabetic systemic condition. If the podiatrist is the one doing the foot exam, this must be documented in agreement by the certifying physician prior to signing the certifying statement for diabetic shoes/inserts.

https://cgsmedicare.com/jc/pubs/news/2010/1110/cope13252.pdf
 
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