Miscellaneous
PHARMACY COMPLIANCE GUIDE (5) Diabetic Shoes – Do It Right the First Time Why would I ever consider doing Diabetic Shoes, Audits, insurance companies, and stinky feet? Is it not worth the hassle? Diabetic shoes are the only preventive medicine Medicare and Medicaid pay for. If done correctly, the process is just that, a process. Just like filling any other prescription. But it takes so much time Yes, it does take time. But whose time does it take? This is not a requirement for the pharmacist to accomplish. Depending on the type of shoe and the state, a manufacturer-trained individual may see and fit a patient for their shoes and inserts. Then there are always the audits Yes, there is a lot of fraud with shoes. But understanding the audit documentation process and the details the auditors are looking for before you see the patient makes all the difference. OK, you make it sound simple. Then why are folks dropping diabetic shoes? It all in the documentation, that is why you must do it right the first time. Then let’s start at the beginning by asking, who is eligible? We are talking about Medicare patients billing through their Part B coverage because this is the most restrictive and most audited process. The patient must be diabetic The patient must have at least one of the following conditions documented by their physician History of partial or complete amputation of the foot History of previous foot ulceration Peripheral Neuropathy with evidence of callus formation Foot deformity Poor circulation Who can sign the prescription for diabetic shoes and inserts? The patient must see a MD, DO, PA, CNPT or Podiatrist for a face-2-face visit and receive a prescription for diabetic shoes and inserts. Once the prescription is received from the patient, a Detailed Written Order is completed and faxed to the individual writing the prescription requesting their signature and their clinical notes. If the prescription was signed by a PA, CNPT or Podiatrist, then the patient must be seen by an MD or DO for another face-2-face visit and a Physician Certification of Therapeutic Footwear is needed along with their clinical notes. If the initial visit was with an MD or a DO, then the Physician Certification of Therapeutic Footwear can be faxed with the Detailed Written Order. You mention clinical notes, pharmacists normally don’t deal with physician’s clinical notes. Why is importation for shoes? Clinical notes are a Medicare Part B, DMEPOS requirement. Almost all audits are lost on the clinical notes. The pharmacist, fitter or billing clerk do not need to be a medical expert to identify what is needed or the problem in the notes. The notes must state: The patient is diabetic Has an approved medical condition that requires the need for diabetic shoes The patient must have at least one of the following conditions documented by their physician History of partial or complete amputation of the foot History of previous foot ulceration Peripheral Neuropathy with evidence of callus formation Foot deformity Poor circulation Prescription was written for both shoes and inserts. You mentioned fitter, can all pharmacists fit diabetic shoes and insert? The fitter is designated by state law, licensure and CMS rules. In every state except Illinois, a Pharmacist Scope of Practice covers the dispensing of a medical device with a legal prescription. All that is needed is the manufacturer’s training and a training certificate. Pharmacy technicians and other staff also require a manufacturer’s training and can fit diabetic shoes under the supervision of the trained pharmacist. DME facilities must follow state licensure requirements when applicable and an in most instances will only dispense heat-moldable inserts. When can the initial fitting occur? The initial fitting can occur at any time after receipt of the initial prescription. The initial fitting is an assessment of the patient to ensure the patient meets the requirements for diabetic...