Podiatry Management Online


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Query: Pre-Payment Audits for Therapeutic Shoes

Medicare is conducting pre-payment audits on most all therapeutic shoe claims that we are submitting. All of my supporting documentation is in place, including certification from the PCP. The problem is that Medicare is also requesting notes from office visits from the PCP to support qualifying findings. Many of the PCPs do not even look at the patient's feet and have no supporting documentation, and therefore our claims are denied.

I send a copy of my note to the PCP for his or her records, however, there still may be no specific documentation from the PCP. The result is that the patient is dispensed shoes, we do not get reimbursed, and cannot bill the patient. Does anyone else have any experience dealing with this? How can you convince your referring doctors to document more thoroughly?


David Dowell, DPM, Joplin, MO

Other messages in this thread:



RE: CA Podiatrist Publishes 600th Issue of Practice Perfect

From: Alan Sherman, DPM


This week, Jarrod Shapiro, DPM has reached the milestone of completing his 600th issue of Practice Perfect. Over the past 12 years, Dr. Shapiro has delivered 600 consecutive weeks of professional insight and mentorship to a generation of podiatrists and those working in the podiatry profession. From the importance of checklists in clinical practice to communication issues to what it means to think like a surgeon to truly enjoying your professional life, Dr. Shapiro has taken us on an introspective examination of our podiatric lives and challenged us to live and practice in a more examined, deliberate, and fulfilling way. Along the way, we have all grown with him. Thanks Jarrod  for sharing your prodigious and active mind with us.


Alan Sherman, DPM, CEO, PRESENT e-Learning Systems



Query: Time Clock, Attendance, and Scheduling Software


Our practice now employs 27 team members and our current facial recognition program is really poor. We tried a fingerprint system before that with similar results. Does anyone utilize a program that imports the data direct to Quickbooks and has features to change employee schedules, monitor tardiness, keep track of PTO (paid time off), and is reliable to use?  I would like employees to be able to log in and out with their computers and/or phones but also make sure they are within a reasonable distance of the office. I have looked at Ximble and Humanity and it looks like Humanity might even remind me of employees' birthdays and work anniversaries.


Jane Graebner, DPM, Delaware, OH



Query: Recommendations for Billing Companies


Can anyone provide me with any contacts and names of billing companies with whom you have had a good relationship, and with whom you are satisfied with both the quality of their work and the fees that are charged for their services?


Dave Williams, DPM, El Paso, TX



Query: Recommendations for 4-Line Phone System


Can anyone recommend a 4-line phone system? All the systems I’ve researched have too many cons, i.e., no caller ID, etc.  I’d prefer a corded system.


Jay Kerner, DPM, Rockville Centre, NY



Query: Bringing an PA/NP into Practice


My practice is expanding and I'm considering bringing on a part-time midlevel provider (PA/NP) to aid in patient care. I recognize that state laws ultimately dictate legality of employment, but I would love to hear the opinions of my colleagues out there who employ or have employed PAs/NPs in their practices. 


P David Applegate, DPM, Katy, TX 



Query: Lidocaine Shortage 


Does anyone have a reliable U.S. distributor with a solution to the current local anesthetic shortage?


Paul Kesselman, DPM, Woodside, NY



Query: Source for Bupivacaine w/Epi


Does anyone know the availability status of bupivacaine 0.5 % with epinephrine? I'm told that it is back ordered from the company. 


Paul A. Galluzzo, DPM, Rockford, IL



Query: Holding Credit Cards on File


If your office is holding credit card numbers (safely offsite, in a cloud, etc.), do you charge off the balance of the account after 30 days or 60 days, or do you create a payment plan at the time of service?


Nicole Freels, DPM, Lexington, KY



Query: Repair of Midmark Equipment


After years of reliable service, we recently experienced a power surge that knocked out two Midmark 417 podiatry chairs and our R9 UltraClave. I need a recommendation for a reliable service company for these products in the Philadelphia area.  


Greg Caringi, DPM, Lansdale, PA



Query: How Often to Change Benz-All Instrument Disinfectant Solution


Can anyone tell me how often we should be changing the Benz-All instrument disinfectant solution in the Bard-Parker trays. Is there literature to cite? 


Ed Dos Remedios, DPM, Providence, RI



Query: Template for Credit Card Collections of Deductibles


Our practice is looking for a method to collect on high deductible patients via pre-authorized credit cards once the insurance company has concluded the claim. Does anyone have a template of a form they use in this regard?


Amy Sepehri, Practice Manager, Chicago, IL



Query: Formula for Value of a Practice


I am in the process of entertaining a bid for the purchase of my now second generation practice. What formula have others who recently sold their practice used to calculate a sale price? There are several rather complicated accounting methods floating around, but I was hoping for a more simple starting point, say X% of gross or X% of net. I recognize that there are a lot of variables in the negotiating process, but was hoping for a simple place to start and perhaps circle back to after the accountants and lawyers churn the pot.


Name Withheld


Editor's comment: PM News does not provide legal advice. In a rapidly changing healthcare environment, there is no magic formula that works for all practices. One thing though is certain. Any formula you start out with MUST be based on a percentage of net. Gross income is a useless figure because three practices with the same gross, e.g., $300,000 can have three radically different net incomes. Net income is the only true measure of how long a prospective buyer will take to repay the loans necessary to purchase a practice.



Query: Online Bills to Patients


Does anyone know whom I can deal with to set up online bills to send to patients' emails?


Jill Hagen, DPM, Englewood, NJ



Query: Keeping Track of Employee Hours


How are offices keeping track of employee hours? A time clock machine? Each person filling out a weekly time sheet? Or something else?


Olga Luepschen, DPM, Sebring, FL



Query: Rationale for Penalizing CR X-Ray Technology


What is the reason for penalizing someone with CR x-ray technology? What makes DR technology deserving of a higher reimbursement?


Jeffrey Kass, DPM, Forest Hills, NY



Query: Storing Charts and HIPAA Compliance


I am a semi-retired podiatrist. My practice consists of a satellite office and a few independent senior facilities. There is a central medical wellness office where I see my patients at the facilities I go to. Because I only work part-time at all of my locations, I store all of my patient charts (still using paper) at home. To be HIPAA-compliant, what precautions do I need to follow when storing patient charts at home? They are kept in a locked closet. 


Name Withheld 


Editor's Comment: PM News does not provide legal advice. Under the HIPAA security rules, covered entities must "Identify and protect against reasonably anticipated threats to the security or integrity of the information." The keyword is "reasonability" and a locked closet meets this requirement. Note: HIPAA is a national minimal standard which can be superceded by state law.



Query: Difficulty Getting Local Anesthetics


Does anyone know why I am having trouble getting Marcaine, Carbocaine, and Xylocaine (proprietary or generic)? I am being told there is a back order and it will be several months. No one seems to know why.


Sam Bell, DPM, Schenectady, NY



Query: Plug-in for Credit Cards


We have been using Spark Pay for several years, which is a plug-in for your phone or tablet to process credit cards with no terminal needed. I just received notification that Capital One is discontinuing Spark Pay on January 31, 2018. Square is a popular alternative, but it has the worst reviews. I ordered PayPal's device but upgraded (for $79) to a unit that will accept the chip, swipe, Apple Pay, and Android payments. It is also wireless to our phone, computer, or tablet. They charge 2.7%. Does anyone have a good or bad experience with Paypal, Square, or other plug-ins? 


George Jacobson, DPM, Hollywood, FL



Query: Best Way to Study for 10-Year Forefoot Boards


Can anyone recommend what is the best way to prepare for the 10- year surgical forefoot boards?


Dean Spellman, DPM, Bronx, NY



Query: Joint Venture with Vascular Surgeon


We have been in touch with a vascular surgeon regarding a potential joint venture. In the past, we did a joint venture with a primary care group, but that business model failed. Our vascular doc insists that they have a lot to gain by having podiatry on their team. Are there any successful models for collaboration? Any advice would be appreciated.


Name Withheld



Query: Board Re-Certification Study Strategies


I am in the group of individuals who takes the self-assessment exam every 10 years for ABFAS re-certification. I understand that it is an educational process, but I still hope to do well on the exam. When I took the re-certification exam 10 years ago, I was surprised that there was a whole section with highly technical questions about bone lengthening (distraction osteogenesis).  I never expected that this was a common enough procedure in our profession to have prepared to answer how many mm/week the distraction device should be advanced.


I believe I practice at a high level and keep up with the current literature. I am hoping that colleagues in my age group and experience can direct me to those topics that might be part of the current practice of podiatry, but were not taught or even known 30 years ago. Any suggestions are appreciated.


Greg Caringi, DPM, Lansdale, PA



Query: Recommendations for Pathology Lab with a Fast Turn-around


I am looking for recommendations for a pathology lab with a streamlined process and fast turn-around time. Any suggestions? 


Daniel Methuselah, DPM, Columbia, SC



Query: Waiting Room Informational/Educational Videos


Does anyone have a resource on companies that produce "looped" video that can be displayed in your waiting room? It would be ideal if this could be customized to feature our docs and some of the specific services we provide.  


Steven Merckx, DPM, Madison, WI



Query: United Health Care Compliance Call


I received an after hours call from United Health Care this evening that was a compliance call. Essentially, UHC calls the office and times how long it takes for the doctor to call back. I've never heard of this or had this happen before. Does anyone know anything about this? I plan to check my contract to see if practitioners are obligated to comply. Any information would be appreciated.


Amy Walsh, DPM, Spring, TX



Query: ABPM Certificate of Added Qualification


Can someone clarify a notice that I received from the ABPM asking to apply for a "Certificate of Added Qualification in Amputation Prevention and Wound Care"? I asked my former residency director and was told that this was not an approved certificate by the CPME or JCRSB even though it is given by an approved board. 


Name Withheld