Recently, a new coding forum entitled codinghelpline.com was launched enabling colleagues to send in coding questions. Not surprisingly, as happens at many conferences, one subscriber ...
Paul Kesselman
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About me
Dr, Kesselman was in private practice in NYC for over 35 years and is board certified by the American Board of Foot and Ankle Surgery. He has over twenty
five years of consulting experience in many areas of health policy providing expertise on Medicare and third party payment regulations.
He is a member of all four DME MAC Medicare Councils and has a regular column in Podiatry Management.
five years of consulting experience in many areas of health policy providing expertise on Medicare and third party payment regulations.
He is a member of all four DME MAC Medicare Councils and has a regular column in Podiatry Management.
Posts made by Paul Kesselman
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Medical Necessity and AFO Coding: A Drop Foot Case Exampleposted in Compliance and reimbursement pearls
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Protecting Your Practice from Consolidated Billingposted in Compliance and reimbursement pearls
Recently, a client was asked by Noridian (DME MAC A) to repay a few hundred dollars for a DME claim submitted six years ago. The patient had been seen in the office while residing in a nurs...
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Your DME Claim Went to the Wrong DME MAC?posted in Compliance and reimbursement pearls
Here’s a Five-Minute, Permanent Fix This is a very common issue. Take a deep breath—don’t panic.In most cases, this can be resolved by your biller and a one-time, five-mi...
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Patient with unknown ID 1posted in Compliance and reimbursement pearls
Changed Medicare Beneficiary Identifier (MBI) I and now your office is hit with a new deductible. Can you solve this problem? Yes you can Win This!! A Medicare patient presents to your off...
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Deductible issues and HSAposted in Compliance and reimbursement pearls
As you start the New Year, be aware that the annual deductibles for most plans reset and start January 1, 2026. Traditional Fee for Service Medicare deductible for 2026 is $283. Other plan de...
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Prosthetics whenposted in Compliance and reimbursement pearls
Many patients, including those with diabetes, PAD, post trauma, etc. frequently present to the podiatrist’s office with relatively minor digital and forefoot amputations. These may or may not...
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Your Role in Preventing DMEPOS Fraud and Protecting Patient Dataposted in Compliance and reimbursement pearls
Recently the Office of Inspector General provided a video on fraud in the DMEPOS world. To say that this is a surprise, one would have had to live under a rock for the last decade. Medicare f...
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Wear that AFOposted in Compliance and reimbursement pearls
A recent article in Rosalind Franklin Medical School Fall/Winter 2025 edition, sparked my interest. Entitled, “This boot is made for walking” was written by a health care provid...
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Hours at time of inspectionposted in Compliance and reimbursement pearls
The last installment of this column presented some issues with the inspection process during either your initial or revalidation process with Medicare as a DME supplier. Since composing tha...
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Quality standardsposted in Compliance and reimbursement pearls
A previous bulletin raised a new term for most reading this bulletin, “Quality Standards Appendix C” What exactly is the “Quality Standards, Appendix C”? The Q...
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3D Orthotics and Prostheticsposted in Compliance and reimbursement pearls
Recently many providers have questioned whether 3-D manufactured orthotics and prosthetics can be coded in the same way as devices manufactured under current traditional manufacturing? The short an...
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Choosing the Right AFO for the Patient - Part 6posted in Compliance and reimbursement pearls
The past five articles have attempted to provide a crash course on AFOs. This is a very challenging subject. The simplicity of the material presented in these articles does not in any way i...
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Choosing the Right AFO for the Patient - Part 5posted in Compliance and reimbursement pearls
In four short articles this series has covered a significant amount of material on the very basics of what is needed to know about ordering an AFO. Now lets dissect what you may need to ha...
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Choosing the Right AFO for the Patient - Part 4posted in Compliance and reimbursement pearls
In continuing the discussion of choosing the right AFO for the Patient. We have now assumed that the patient requires a custom fabricated AFO. This brief installment is by no means a substitute for...
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Choosing the Right AFO for the patient - Part 3posted in Compliance and reimbursement pearls
In the two previous installments of Choosing the Right AFO for the patient, the issues of OTC and custom fitting were presented and the Same or Similar issue was reviewed with a real-life example o...
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Choosing the Right AFO for the patient - Part 2posted in Compliance and reimbursement pearls
Part 1 of this series presented some issues to address with regards to OTC and custom fitted orthosis. Part 2 will continue with more information on other issues and choices to be made when it come...
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Choosing the Right AFO for the patient - Part 1posted in Compliance and reimbursement pearls
A recent phone call from a retired colleague concerning their family members’ AFO status is the basis for the next several articles. Just how does one determine which AFO is correct for the p...
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Medicare Advantage Coverage of Foot Orthoticsposted in Compliance and reimbursement pearls
A recent question to an online forum posed this question: Does Medicare Advantage provide coverage for foot orthotics without the shoe being attached to a leg brace? A new patient insists that the...
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Retired and Auditedposted in Compliance and reimbursement pearls
I retired from practice about three years ago and sold the practice. Now the DME MAC (CGS) agency is auditing me, saying I owe a substantial amount of money back for AFOs, CAM Boots and surgical dr...
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How does one deal with a disgruntled patient who newly presents to your office with a shopping bag full of footposted in Compliance and reimbursement pearls
So, if you have a disgruntled patient with a shopping bag of foot orthotics which have failed to properly resolve the patient’s complaints. You have determined that no modifications to thos...
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