Footwear guidance still missing in 2005

Monday, February 28, 2005

WASHINGTON - The wait continues for DME providers and pharmacists concerned about their status as qualified therapeutic footwear fitters.

Despite actions last year by the National supplier Clearinghouse that suggested a change was imminent, CMS had yet to issue an update by early 2005, as some industry watchers expected.

“Nothing has happened yet, but you never know. A change could come in three days, three months or three years,” said Bill Popomaronis, the National Community Pharmacists Association’s (NCPA) vice president of long-term/home health care pharmacy services.

Popomaronis and others in the industry expect Medicare to redefine who is considered qualified to fit and furnish diabetic footwear. While the current rule defines qualified suppliers as a podiatrist or “other qualified individual” - which has long been interpreted to include pharmacists and HMEs - many believe a change will limit suppliers to podiatrists, pedorthotists, orthotists, prosthetitists or certified orthotic fitters. The NSC last spring actually issued, then rescinded, this change, and some healthcare attorneys have reported cases of DME providers being denied supplier numbers because they distributed the footwear.

“Right now pharmacists can continue to dispense therapeutic shoes and make their own efforts to reach higher ground by taking courses to increase their competency,” said Popomaronis.

Those efforts could include becoming a BOC or ABC certified orthotic fitter or going through a pedorthotist program. The NCPA also has developed a 40-hour program that trains pharmacists how to properly fit the shoes, said Popomaronis.

“When CMS and the NSC make their changes, we’ll look to make sure that we help to achieve their goals of positive patient outcomes and protecting the beneficiaries,” he said.

Despite the delay from Medicare, DMERC Region A took action on diabetic shoes in January. The Region A carrier, TriCenturion launched a widespread service specific pre-payment probe review of diabetic shoes and inserts.

The review was prompted by data analysis that indicated a significant increase in allowed charges for HCPCS codes A5500, A5501, K0628 and K0629 in Region A.