Compliance and reimbursement pearls | KRM Forum

Compliance and reimbursement pearls

Monthly column on billing and coding issues important to orthotic providers. These columns will provide you with a brief but thorough rationale on orthotic/prosthetic policies and billing practices.

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Back to Basics Coding Compliance for Foot Orthotics - Part 1
9/10/26, 8:56 AM • Paul Kesselman 9/10/26, 8:56 AM

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Paul Kesselman
9/10/26, 8:56 AM

Real life experiences often necessitate one look at the very basics and essence of one’s oc...
K Modifier
9/3/26, 10:02 AM • Paul Kesselman 9/3/26, 10:02 AM

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Paul Kesselman
9/3/26, 10:02 AM

This week’s column answers a question from a reader: "I recently billed for a L5020 Tibial...
PECOS Issues
8/27/26, 9:54 AM • Paul Kesselman 8/27/26, 9:54 AM

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Paul Kesselman
8/27/26, 9:54 AM

Hopefully, this will be the last article on enrollment for a while. My own recent personal experi...
CMS Launches Yet Another Reason for Providers To Take Enrollment Seriously
8/20/26, 10:38 AM • Paul Kesselman 8/20/26, 10:38 AM

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Paul Kesselman
8/20/26, 10:38 AM

On the heels of all the DME enrollment segments, CMS has announced several new, potenti...
A5512 vs A5513 or A5514
8/13/26, 12:00 PM • Paul Kesselman 8/13/26, 12:00 PM

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Paul Kesselman
8/13/26, 12:00 PM

This is a continuation of the past week’s discussion on whether there is a bell c...
A5512 vs A5514
8/5/26, 2:40 PM • Paul Kesselman 8/5/26, 2:40 PM

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Paul Kesselman
8/5/26, 2:40 PM

A colleague recently asked a question regarding the existence of a bell curve by which ...
AFO not in scope
7/30/26, 9:51 AM • Paul Kesselman 7/30/26, 9:51 AM

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Paul Kesselman
7/30/26, 9:51 AM

A colleague recently contacted me that a state carrier denied his claim for an AFO beca...
60K lost due to non complaince with reenrollment
7/16/26, 6:50 AM • Paul Kesselman 7/16/26, 6:50 AM

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Paul Kesselman
7/16/26, 6:50 AM

It’s truly amazing how the real world of DME enrollment tragedies continues, this...
When Medicare Says You Didn’t Write an Order to Yourself
7/10/26, 7:14 AM • Paul Kesselman 7/10/26, 7:14 AM

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Paul Kesselman
7/10/26, 7:14 AM

The other day, a physician who is also a certified coder called me with a Medicare audi...
The Orthopedic Surgeon Who Went to Prison Over an Enrollment Form
7/1/26, 10:08 AM • Paul Kesselman 7/1/26, 10:08 AM

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Paul Kesselman
7/1/26, 10:08 AM

An Orthopedic Surgeon Went to Prison Over a Medicare Enrollment Form. Seriously. Most doctors wo...
CEDI Front-End Rejections: Common Errors and Simple Fixes
6/25/26, 9:54 AM • Paul Kesselman 6/25/26, 9:54 AM

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Paul Kesselman
6/25/26, 9:54 AM

Every month the Common Electronic Data Interchange (CEDI) which electronically processes your DME...
When Same and Similar Meets Wedding Planning
6/17/26, 9:42 AM • Paul Kesselman 6/17/26, 9:42 AM

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Paul Kesselman
6/17/26, 9:42 AM

Not much has changed since this column began about the issue of Same and/or Similar. To pr...
Patients Status Post TMA: Addressing More Advanced Biomechanical Needs
6/11/26, 11:31 AM • Paul Kesselman 6/11/26, 11:31 AM

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Paul Kesselman
6/11/26, 11:31 AM

The first installment addressing the biomechanical needs of patients’ status post trans met...
Trans Metatarsal Amputation (TMA)
6/4/26, 8:30 AM • Paul Kesselman 6/4/26, 8:30 AM

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Paul Kesselman
6/4/26, 8:30 AM

A colleague asked are there common biomechanical traits and needs for patients who have undergone...
Prior Auth & Competitive Bidding
5/25/26, 7:04 AM • Paul Kesselman 5/25/26, 7:04 AM

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Paul Kesselman
5/25/26, 7:04 AM

Medicare, as with other third-party payers, has had to contend with an explosion of reimbursement...
Staying Current With DME Enrollment Requirements
5/21/26, 11:52 AM • Paul Kesselman 5/21/26, 11:52 AM

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Paul Kesselman
5/21/26, 11:52 AM

In last week’s column, we discussed several common DME enrollment issues. Two gro...
DME Enrollment Issues
5/14/26, 11:45 AM • Paul Kesselman 5/14/26, 11:45 AM

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Paul Kesselman
5/14/26, 11:45 AM

Over the past several months, many providers have discovered that their DME licenses (PTANs) are ...
CFO vs AFO
5/7/26, 9:27 AM • Paul Kesselman 5/7/26, 9:27 AM

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Paul Kesselman
5/7/26, 9:27 AM

Having recently attended an out of state podiatry conference, it provided an opportunit...
Add on codes
4/29/26, 10:50 AM • Paul Kesselman 4/29/26, 10:50 AM

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Paul Kesselman
4/29/26, 10:50 AM

Recently a colleague asked whether he could be reimbursed for a soft tissue interface f...
New AFO PA language
4/22/26, 11:04 AM • Paul Kesselman 4/22/26, 11:04 AM

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Paul Kesselman
4/22/26, 11:04 AM

Local Carrier Determinations (LCD) for all products and services provided by medical professional...

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Compliance and reimbursement pearls

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Back to Basics Coding Compliance for Foot Orthotics - Part 1

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PECOS Issues