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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Choosing the Right AFO for the Patient - Part 4
10/9/25, 1:34 PM • Paul Kesselman 10/9/25, 1:34 PM

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Paul Kesselman
10/9/25, 1:34 PM

In continuing the discussion of choosing the right AFO for the Patient. We have now assumed that ...
Choosing the Right AFO for the patient - Part 3
10/8/25, 7:47 AM • Paul Kesselman 10/8/25, 7:47 AM

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Paul Kesselman
10/8/25, 7:47 AM

In the two previous installments of Choosing the Right AFO for the patient, the issues of OTC and...
Choosing the Right AFO for the patient - Part 2
10/1/25, 2:16 PM • Paul Kesselman 10/1/25, 2:16 PM

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Paul Kesselman
10/1/25, 2:16 PM

Part 1 of this series presented some issues to address with regards to OTC and custom fitted orth...
Choosing the Right AFO for the patient - Part 1
9/19/25, 2:03 PM • Paul Kesselman 9/19/25, 2:03 PM

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Paul Kesselman
9/19/25, 2:03 PM

A recent phone call from a retired colleague concerning their family members’ AFO status is...
Medicare Advantage Coverage of Foot Orthotics
9/17/25, 8:47 AM • Paul Kesselman 9/17/25, 8:47 AM

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Paul Kesselman
9/17/25, 8:47 AM

A recent question to an online forum posed this question: Does Medicare Advantage provide covera...
Retired and Audited
9/9/25, 7:07 AM • Paul Kesselman 9/9/25, 7:07 AM

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Paul Kesselman
9/9/25, 7:07 AM

I retired from practice about three years ago and sold the practice. Now the DME MAC (CGS) agency...
How does one deal with a disgruntled patient who newly presents to your office with a shopping bag full of foot
9/2/25, 9:17 AM • Paul Kesselman 9/2/25, 9:17 AM

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Paul Kesselman
9/2/25, 9:17 AM

So, if you have a disgruntled patient with a shopping bag of foot orthotics which have failed to ...
How do I deal with a patient with a shopping bag full of orthotics
8/27/25, 7:49 AM • Paul Kesselman 8/27/25, 7:49 AM

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Paul Kesselman
8/27/25, 7:49 AM

How does one deal with a disgruntled patient who newly presents to your office with a shopping ba...
Foot Orthotics and Medicare
8/19/25, 10:21 AM • Paul Kesselman 8/19/25, 10:21 AM

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Paul Kesselman
8/19/25, 10:21 AM

A provider once told me that one can bill Medicare to get paid for orthotic using the KX modifier...
Stark Issues
8/12/25, 10:11 AM • Paul Kesselman 8/12/25, 10:11 AM

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Paul Kesselman
8/12/25, 10:11 AM

I am concerned that I may be violating Stark issues because of some materials I read in another f...
Do I need FA and SB
8/6/25, 8:28 AM • Paul Kesselman 8/6/25, 8:28 AM

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Paul Kesselman
8/6/25, 8:28 AM

I've recently heard that Medicare to combat fraud is going to institute a yearly Facility Accredi...
Audits of Custom Fitted
7/29/25, 2:12 PM • Paul Kesselman 7/29/25, 2:12 PM

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Paul Kesselman
7/29/25, 2:12 PM

Several months ago, this column addressed the difference between custom fit and off the shelf AFO...
Inspection Letter 2
7/23/25, 7:26 AM • Paul Kesselman 7/23/25, 7:26 AM

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Paul Kesselman
7/23/25, 7:26 AM

I am freaking out about a DME inspection. What do I do Part 2: At the time of the insp...
Inspection Letter
7/15/25, 11:21 AM • Paul Kesselman 7/15/25, 11:21 AM

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Paul Kesselman
7/15/25, 11:21 AM

I am freaking out, I got a letter notifying me that the DME inspector is coming. What do I do?? ...
Part V: Custom Milled Insert or Toe Filler, Can I provide Both??
7/2/25, 7:04 AM • Paul Kesselman 7/2/25, 7:04 AM

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Paul Kesselman
7/2/25, 7:04 AM

In this last series of articles on therapeutic shoe/insert claims, there is another common scenar...
Part IV: Therapeutic Shoe Insert Dilemma: A5514 or L3000-L3020?
6/25/25, 10:05 AM • Paul Kesselman 6/25/25, 10:05 AM

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Paul Kesselman
6/25/25, 10:05 AM

The previous three issues of this newsletter revolved around how to know whether a pati...
Part III: Therapeutic Shoe Insert A5514 Ordering dilemma
6/18/25, 11:42 AM • Paul Kesselman 6/18/25, 11:42 AM

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Paul Kesselman
6/18/25, 11:42 AM

Part I of this series on therapeutic shoe insert coverage, discussed the “Same and Si...
Therapeutic Shoe Insert Coverage - Part 2
6/11/25, 12:47 PM • Paul Kesselman 6/11/25, 12:47 PM

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Paul Kesselman
6/11/25, 12:47 PM

Here’s a common scenario: The Patient only wants inserts and they already have sh...
How to Empower Yourself and Avoid Denials
6/4/25, 9:41 AM • Paul Kesselman 6/4/25, 9:41 AM

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Paul Kesselman
6/4/25, 9:41 AM

Patients often either are misleading, lie or simply are confused and can’t remember when th...
Billing and Timing of CFO and AFO for PTTD patients
5/27/25, 9:08 AM • Paul Kesselman 5/27/25, 9:08 AM

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Paul Kesselman
5/27/25, 9:08 AM

Dr. Blake’s recent articles on Posterior Tibial Dysfunction have provided a great deal of c...

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