A colleague asked are there common biomechanical traits and needs for patients who have undergone a trans metatarsal amputation? Yes. Patients who undergo a trans metatarsal amputation (TMA) commo...
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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Trans Metatarsal Amputation (TMA)posted in Compliance and reimbursement pearls
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Prior Auth & Competitive Biddingposted in Compliance and reimbursement pearls
Medicare, as with other third-party payers, has had to contend with an explosion of reimbursements associated with an increase in utilization of a wide variety of medical/surgical services. To redu...
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Staying Current With DME Enrollment Requirementsposted in Compliance and reimbursement pearls
In last week’s column, we discussed several common DME enrollment issues. Two groups of suppliers were identified as being at high risk for revocation. The first group includes provid...
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DME Enrollment Issuesposted in Compliance and reimbursement pearls
Over the past several months, many providers have discovered that their DME licenses (PTANs) are being rejected. The largest group affected includes providers attempting revalidation who either han...
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CFO vs AFOposted in Compliance and reimbursement pearls
Having recently attended an out of state podiatry conference, it provided an opportunity to mingle with colleagues and vendors who offered a rare opportunity for “clinical” inte...
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Add on codesposted in Compliance and reimbursement pearls
Recently a colleague asked whether he could be reimbursed for a soft tissue interface for an Ankle Foot Orthotics (AFO). Most readers here would automatically respond yes as there is a lita...
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New AFO PA languageposted in Compliance and reimbursement pearls
Local Carrier Determinations (LCD) for all products and services provided by medical professionals, must go through arduous review process in accordance with the 21st Century Cures Act. To avoid th...
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Second Pair Coverage for Custom Orthotics: What Clinicians Should Knowposted in Compliance and reimbursement pearls
A common question in practice is whether insurance will cover a second pair of custom orthotics within the same year. The answer is not always straightforward. Coverage fo...
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Neuro Part 3: Advanced AFO Prescriptionposted in Compliance and reimbursement pearls
This week’s issue builds on our previous discussions by moving beyond general AFO concepts into something far more exciting: how to confidently prescribe solutions that truly change t...
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Coding vs Reimbursement Part 2posted in Compliance and reimbursement pearls
In Part 1 we presented an overview of coding and began to ask some questions about reimbursement. Now let’s dive a bit deeper into a bit more of the orthotic reimbursement issue… &nbs...
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Coding vs Reimbursement Part 1posted in Compliance and reimbursement pearls
Over the past few decades one of the most common questions posed by most providers is how do I code for a … so I can get paid for? That “innocent” question is anyt...
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Neuro Exam 2posted in Compliance and reimbursement pearls
The last few installments of this column have provided some insights into how the neurological component of your examination provides both clinical and coding justification for specific AFO. Today&...
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Neuro Examposted in Compliance and reimbursement pearls
In a previous edition of this column, we began an initial discussion of the documentation required to support the medical necessity for a drop foot brace. This week’s column will star...
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Moratorium on new supplier enrollmentposted in Compliance and reimbursement pearls
Some late breaking news from CMS requires a slight delay in Part 2 of the elements of documentation of neurological workup to substantiate the need for AFO. Last week, the President announ...
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Medical Necessity and AFO Coding: A Drop Foot Case Exampleposted in Compliance and reimbursement pearls
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 ...
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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...
