Certifying Physician Chart Notes: Required Medicare Compliance Documentation for Therapeutic Shoes and Inserts

A checklist of must-have Certifying Physician Chart Notes as it relates to Required Medicare Compliance Documentation for Therapeutic Shoes and Inserts

Medicare compliance rules can be confusing. A number of different forms must be completed by each of several practitioner who are all required to be part of the process. Fundamental to the program is the assumption that prevention of diabetic wounds can be best prevented when patients have a team approach to their care. As such, the Medicare shoe program requires the participation of, and makes clear the responsibilities of the:

  • Prescriber who writes the order (prescription) for therapeutic shoes and inserts.
  • Supplier who fits the footwear, and
  • Certifying Physician who manages patients’ diabetes care.

Over the past few years, the incidence of Medicare pre-payment reviews and inconsistency of enforcement caused many practitioners to stop fitting shoes. Fortunately, this has ended for the most part. Practitioners are encouraged to identify patients at risk for ulceration and ensure they get fit with the shoes they need.

Here’s a clear explanation of  what you must include in the Certifying Physician Chart Notes

The Certifying Physician is defined as a doctor of medicine (M.D.) or a doctor of osteopathy (D.O.) who is responsible for diagnosing and treating the beneficiary’s diabetic systemic condition through a comprehensive plan of care. The certifying physician may not be a podiatrist, physician assistant, nurse practitioner, or clinical nurse specialist.

Have an in-person visit with the beneficiary during which diabetes management is addressed within 6 months prior to delivery of the shoes/inserts;

Supporting Chart Notes Checklist:

  • Evaluation was performed by the Certifying Physician (must be M.D or D.O)
  • Visit occurred within 6 months prior to delivery
  • Must document patient is diabetic, and include management plan

Abbreviations commonly used to describe diabetes include:

  • DM (diabetes mellitus)
  • IDDM (insulin dependent diabetes mellitus)
  • Type 1
  • Type 2
  • NIDDM (non insulin dependent diabetes mellitus)

Tests include:

  • HbA1C (Hemoglobin A1C)

Common diabetic medications:

  • Actos (pioglitazone)
  • Avandia (rosiglitazone)
  • Byetta (exenatide)
  • DiaBeta (glyburide)
  • Glucophage (metformin)
  • Glucovance (glyburide and metformin)
  • Glynase (glyburide)
  • Glyset (miglitol)
  • Humalog (insulin lispro)
  • Insulin Isophane
  • Invokana (canaglifozin)
  • Januvia (sitagliptin)
  • Kazano (alogliptin and metformin)
  • Lantus (insulin glargine)
  • Nesina (alogliptin)
  • NovoLog (insulin aspart)
  • Onglyza (saxagliptin)
  • Oseni (alogliptin and pioglitazone)
  • Prandin (repaglinide)
  • Precose (acarbose)
  • Starlix (nateglinide)
  • Tanzeum (albiglutide)
  • Tradjenta (Linagliptin)
  • Victoza (liraglutide)

Only obtained from MD/DO if prepayment audit. WorryFree DME process asks date of patient visit when diabetes management performed. Determination has been made that better to only request MD / DO chart notes in event of audit and not prior to fitting every pair of shoes.

For more information, here is a short video:

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