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Dear Colleagues & Guests:

As I understand it, Medicare's prepayment review can be done for any
service that falls under the "DMEPOS" umbrella and it is nationwide.
Evidently, at the moment, the target is therapeutic shoes and I know
that some facilities, including a doctor's office have had requests for
the documentation. In my opinion, this will serve O&P well in the long
term. Think about the scam artists who have been working the therapeutic
shoe system for years going from nursing home to nursing home with their
wares. Hopefully, some of this will come to a screeching halt as
legitimate documentation is requested by Medicare. I've even seen some
of these folks working at State and County fairs over the years.
Frankly, the law is very clear about who is and who is not eligible for
these services and most of us know that this has gotten out of hand.

Wil Haines, CPO


Thomas M. Wilson wrote:
> Dear List,
>
>
>
> I am hearing from some of my C.Ped. friends that in region B Medicare
> has instituted a "Prepayment Review for Therapeutic Shoes" making the
> supplier of shoes and inserts for diabetics to submit a bunch more
> documentation and they are having big issues. After this "review", if
> Medicare feels the primary care physician's documentation does not prove
> a comprehensive diabetic care plan, the claim is denied and the patient
> is NOT responsible for payment. We have been fortunate enough not to
> have been required to submit the additional paperwork - yet.
>
>
>
> My question is that I have only heard from a few region B C.Peds, and I
> can't find any documentation from Medicare implementing this in any
> other region. Can anyone send me a link or a clue if Medicare is going
> to or have already initiated this in other regions? (I am in region C.)
>
>
>
> Any guidance will be greatly appreciated! I will post appropriate
> replies.
>
>
>
> Thank you all.
>
>
>
> Thomas M. Wilson
>
> Certified Licensed Orthotist
>
> Certified Licensed Pedorthist
>
>
>
>
>
>
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