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...
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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Choosing the Right AFO for the patient - Part 1posted in Compliance and reimbursement pearls
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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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How do I deal with a patient with a shopping bag full of orthoticsposted in Compliance and reimbursement pearls
How does one deal with a disgruntled patient who newly presents to your office with a shopping bag full of foot orthotics? This scenario happens all too often to many orthotic providers, especiall...
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Foot Orthotics and Medicareposted in Compliance and reimbursement pearls
A provider once told me that one can bill Medicare to get paid for orthotic using the KX modifier. Is this really a realistic expectation? If it is not realistic, what repercussions can one expect ...
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Stark Issuesposted in Compliance and reimbursement pearls
I am concerned that I may be violating Stark issues because of some materials I read in another forum. I provide my patients with DME, such as AFO and foot orthotics and other Designated Health Ser...
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Do I need FA and SBposted in Compliance and reimbursement pearls
I've recently heard that Medicare to combat fraud is going to institute a yearly Facility Accreditation and they have also started cracking down on something I never heard of Surety Bonding. What i...
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Audits of Custom Fittedposted in Compliance and reimbursement pearls
Several months ago, this column addressed the difference between custom fit and off the shelf AFOs. Compliance with proper documentation is still insufficient as RAC and other post payment audits c...
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Inspection Letter 2posted in Compliance and reimbursement pearls
I am freaking out about a DME inspection. What do I do Part 2: At the time of the inspection the inspector may ask you to prove that you are compliant with all of the 30 Supplier Standards...
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Inspection Letterposted in Compliance and reimbursement pearls
I am freaking out, I got a letter notifying me that the DME inspector is coming. What do I do?? I got a letter from Palmetto GBA saying they are making a site visit. I am meticul...
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Part V: Custom Milled Insert or Toe Filler, Can I provide Both??posted in Compliance and reimbursement pearls
In this last series of articles on therapeutic shoe/insert claims, there is another common scenario often faced by those providing services covered by the Medicare Therapeutic Shoe Policy. In this ...
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Part IV: Therapeutic Shoe Insert Dilemma: A5514 or L3000-L3020?posted in Compliance and reimbursement pearls
The previous three issues of this newsletter revolved around how to know whether a patient has already received inserts under the therapeutic shoe program, do they need to receive shoes at ...
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Part III: Therapeutic Shoe Insert A5514 Ordering dilemmaposted in Compliance and reimbursement pearls
Part I of this series on therapeutic shoe insert coverage, discussed the “Same and Similar” issues of providing inserts and in the second we discussed providing inserts as a stand...
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Therapeutic Shoe Insert Coverage - Part 2posted in Compliance and reimbursement pearls
Here’s a common scenario: The Patient only wants inserts and they already have shoes. Is this allowed? This is an all-too-common scenario where a patient states t...
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How to Empower Yourself and Avoid Denialsposted in Compliance and reimbursement pearls
Patients often either are misleading, lie or simply are confused and can’t remember when they last received their therapeutic shoe/ inserts. How can you be as close to 100% sure that the pati...
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Billing and Timing of CFO and AFO for PTTD patientsposted in Compliance and reimbursement pearls
Dr. Blake’s recent articles on Posterior Tibial Dysfunction have provided a great deal of clinical information on the assessment and treatment of this condition. These clinical challenges are...
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AFO claims are not being processed by my DME Carrierposted in Compliance and reimbursement pearls
Q: AFO claims are not being processed by my DME Carrier. What do I do? My AFO claims (custom and off the shelf) are being rejected by my clearinghouse, which has sent me a list of the reje...
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Clinical and Reimbursement Challenges of Crow Boots (Part 2)posted in Compliance and reimbursement pearls
Part 1 of this two-part article dealt with clinical issues surrounding Crow Boots. This second and final installment deals with the reimbursement and coding of this very sophisticated device. &nbs...
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Clinical and Reimbursement Challenges of Crow Boots (Part 1)posted in Compliance and reimbursement pearls
There is a myriad of clinical and reimbursement challenges associated with CROW Boots. Recently a client contacted me having had their multi-line claim for a crow boot rejected because the HCPCS c...
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