NSC targets footwear

Sunday, October 31, 2004

GREENVILLE, S.C. - Medicare is developing a rule that would redefine who is qualified to fit and furnish therapeutic shoes, according to a CMS official, but those involved in the business say such a change will come as no surprise.

“Right now, if someone sends in an application and they check that they are doing diabetic shoes, I can guarantee that the National Supplier Clearinghouse is going to ask what the provider’s certification is,” said Denise Fletcher, an attorney with Brown and Fortunato. “I’ve had that happen [to my clients], and I have had to go back to them to say there is no rule out there on this.”

Kelly Pickens, an attorney with the Health Law Center in Greenville, S.C., said she has had a client who lost an administrative appeal and lost their Medicare supplier number because they were found to be unqualified to provide the shoes.

In that case, the provider originally received a favorable ruling from a hearing officer saying they were in compliance with Supplier Standards Four, 10 and 14. The NSC, however, fired back with an appeal saying there was also a violation of Standard One because the provider, who furnished therapeutic shoes, was not a podiatrist, orthotist or “other qualified individual.”

“For [the NSC] to come along and say we are retroactively taking your number away because you haven’t complied with a rule we never communicated to you in the first place, that’s a big problem,” said Pickens.

The NSC did not return calls for this article.

In May, the NSC posted revised guidelines for diabetic shoes that limited who was qualified to furnish the product. While the current rule defines qualified suppliers as a podiatrist or other qualified individual - which has long been interpreted to include pharmacists and HMEs - the bulletin limited suppliers to podiatrists, pedorthotists, orthotists, prosthetitists or certified orthotic fitters. The change was quickly removed from the Web site, however, following questions of due process.

Medicare is now in the process of interpreting “other qualified individual,” said a CMS official in September. Although no publication date had been set, the change will be published as a Notice of Proposed Rulemaking and will include a comment period.

Until the issue is resolved, Pickens and Fletcher have been advising their clients to considering becoming BOC or ABC certified orthotic fitters or going through a pedorthotist program.

“My clients want to know what the rules are,” said Fletcher. “They say, ‘I’ll play by the rules, but just tell me what they are. Don’t hide them from me and don’t all of a sudden come and tell me I am doing it wrong after years in business.’”