Medicare stays mum on who can supply therapeutic shoes

Sunday, January 30, 2005

January 31, 2005

WASHINGTON - The wait continues for DME providers and pharmacists concerned about their status as qualified therapeutic footwear fitters.
Industry watchers expected CMS to clarify who can furnish the footwear by the end of 2004, but nothing official has yet been released.
“We think that clarification is going to be to tighten things up and not allow manufacturer certificates anymore,” said one industry source.”
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 The NSC last spring issued then rescinded this change, and some healthcare attorneys have reported cases of DME providers being denied a supplier number because they distributed the footwear.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 Bill Popomaronis, vice president of long term and home health care pharmacy services  for the National Community Pharmacists Association.
Those efforts could include becoming a BOC or ABC certified orthotic fitters 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. The Region A carrier, TriCenturion, in January 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.  Suppliers whose claims were selected for the review were contacted and asked to submit additional information for their claims to determine if they were reasonable and necessary under Medicare criteria.