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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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...
AFO claims are not being processed by my DME Carrier
5/14/25, 11:50 AM • Paul Kesselman 5/14/25, 11:50 AM

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Paul Kesselman
5/14/25, 11:50 AM

Q: AFO claims are not being processed by my DME Carrier. What do I do? My AFO claims (cu...
Clinical and Reimbursement Challenges of Crow Boots (Part 2)
5/7/25, 1:18 PM • Paul Kesselman 5/7/25, 1:18 PM

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Paul Kesselman
5/7/25, 1:18 PM

Part 1 of this two-part article dealt with clinical issues surrounding Crow Boots. This second an...
Clinical and Reimbursement Challenges of Crow Boots (Part 1)
4/30/25, 7:44 AM • Paul Kesselman 4/30/25, 7:44 AM

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Paul Kesselman
4/30/25, 7:44 AM

There is a myriad of clinical and reimbursement challenges associated with CROW Boots. Recently ...
Casting for Orthotics or AFO
4/22/25, 5:40 AM • Paul Kesselman 4/22/25, 5:40 AM

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Paul Kesselman
4/22/25, 5:40 AM

I am a bit confused over what is the proper code for casting/scanning/or using bio foam when taki...
L1952 vs L1951
4/16/25, 2:34 AM • Paul Kesselman 4/16/25, 2:34 AM

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Paul Kesselman
4/16/25, 2:34 AM

Part 2 of L1951 and L1952 Effective April 1, 2025, CMS has introduced several ...
Hours or by appointment
4/16/25, 2:18 AM • Paul Kesselman 4/16/25, 2:18 AM

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Paul Kesselman
4/16/25, 2:18 AM

Many physician practices are facing harsh economic times with Medicare payments continu...
Fee Schedule Look Up and Research
4/16/25, 1:55 AM • Paul Kesselman 4/16/25, 1:55 AM

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Paul Kesselman
4/16/25, 1:55 AM

Several clients have requested the entire DME fee schedule for 2025, thinking that all DMEPOS pay...
Fee Schedules for specific products
4/16/25, 1:53 AM • Paul Kesselman 4/16/25, 1:53 AM

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Paul Kesselman
4/16/25, 1:53 AM

As most of you know, the DME MAC fee schedule is updated yearly. As opposed to the complex formul...
Spiral Rehab AFO’s: Part 1
4/1/25, 1:34 AM • Paul Kesselman 4/1/25, 1:34 AM

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Paul Kesselman
4/1/25, 1:34 AM

A common AFO L1951: Ankle foot orthosis (AFO), spiral, (institute of rehabilitative medicine type...
Staying a DMEPOS provider worth the costs
1/15/25, 11:46 AM • Paul Kesselman 1/15/25, 11:46 AM

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Paul Kesselman
1/15/25, 11:46 AM

In the face of many DME issues, many ask if continuing as a DMEPOS provider is worth th...
Surety Bond Follow up
10/8/24, 10:33 AM • Paul Kesselman 10/8/24, 10:33 AM

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Paul Kesselman
10/8/24, 10:33 AM

A recent posting outlining what happened to a pedorthic provider has some readers a bit...

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