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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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...
Surety bond as example of what not to do
9/11/24, 10:47 AM • Paul Kesselman 9/11/24, 10:47 AM

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Paul Kesselman
9/11/24, 10:47 AM

A recent encounter with a provider of DMEPOS (not a podiatrist, but a pedorthist) shoul...
L1951 3rd posting
8/21/24, 8:07 AM • Paul Kesselman 8/21/24, 8:07 AM

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Paul Kesselman
8/21/24, 8:07 AM

The past two forum postings have reviewed the DMEPOS prior authorization process and the clinical...
L1951 2nd forum posting
8/7/24, 7:50 AM • Paul Kesselman 8/7/24, 7:50 AM

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Paul Kesselman
8/7/24, 7:50 AM

The last forum discussed the DMEPOS prior authorization program as one way of CMS stemming the fl...
Prior Authorization Program
7/24/24, 8:07 AM • Paul Kesselman 7/24/24, 8:07 AM

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Paul Kesselman
7/24/24, 8:07 AM

Medicare, in its attempt to stem payments to providers and reduce fraud and abuse, CMS has now ex...
Proper Documentation for Custom Foot Orthotics 9
6/24/24, 5:40 PM • Paul Kesselman 6/24/24, 5:40 PM

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Paul Kesselman
6/24/24, 5:40 PM

Many clients have asked beyond the HCPCS codes for custom fabricated foot orthotics and casting c...
Proper Documentation for Custom Foot Orthotics 8
6/12/24, 9:25 AM • Paul Kesselman 6/12/24, 9:25 AM

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Paul Kesselman
6/12/24, 9:25 AM

Many clients have asked how to bill Medicare for custom foot orthotics when the patient’s s...
Proper Documentation for Custom Foot Orthotics 7
5/29/24, 12:04 PM • Paul Kesselman 5/29/24, 1:08 PM

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Richard Blake
5/29/24, 1:08 PM

Excellent discussion. Can not wait for the Medicare discussion next week!!! Rich Blake
Proper Documentation for Custom Foot Orthotics 6
5/14/24, 10:38 AM • Paul Kesselman 5/14/24, 10:38 AM

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Paul Kesselman
5/14/24, 10:38 AM

The last four installments in this forum dealt with the three steps of required documen...
Proper Documentation for Custom Foot Orthotics 5
4/10/24, 12:13 PM • Paul Kesselman 4/10/24, 12:13 PM

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Paul Kesselman
4/10/24, 12:13 PM

The last four installments in this forum dealt with the three steps of required documentation f...

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