What should be included when Dispensing Chart Notes for Therapeutic Shoes as it relates to the 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 to do when Dispensing Chart Notes for Therapeutic Shoes.
At the time of delivery of the items selected, the supplier must conduct and document an in-person visit with the beneficiary.
Depending on the items ordered, both the evaluation and delivery could occur on the same day if the supplier had both a sufficient array of sizes and types of shoes/inserts and adequate equipment on site to provide the items that meet the beneficiary’s needs. Both components of the visit must be clearly documented.
- Criterion 5 states that “At the time of delivery of the items selected, the supplier must conduct and document an in-person visit with the beneficiary.”
- Must be conducted with the beneficiary wearing the shoes and inserts and must document that the shoes/inserts/modifications fit properly. (per “Policy Specific Documentation Requirements”)
Medicare requires that there be documentation of objective findings that the shoes fit well such as that during gait, there is no heel slippage, the there is an appropriate amount of room around the toes and that there is total contact with the footbed.
Simply stating subjective comments that the shoes “feel good” can be interpreted as not being adequate and could run the risk of not meeting the LCD criteria.
For additional information, see:
Medicare Documentation Checklist
And also watch this quick video: