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...
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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Do I need FA and SBposted in Compliance and reimbursement pearls
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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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Casting for Orthotics or AFOposted in Compliance and reimbursement pearls
I am a bit confused over what is the proper code for casting/scanning/or using bio foam when taking a negative impression for foot/ankle foot orthotics? This is multiple questions rolled into one ...
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L1952 vs L1951posted in Compliance and reimbursement pearls
Part 2 of L1951 and L1952 Effective April 1, 2025, CMS has introduced several new HCPCS codes affecting lower extremity providers. The first example this article will cover is L1...
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Hours or by appointmentposted in Compliance and reimbursement pearls
Many physician practices are facing harsh economic times with Medicare payments continuing to be cut. Recent estimates adjusted for inflation claim physician payments, adjusted for inflatio...
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Fee Schedule Look Up and Researchposted in Compliance and reimbursement pearls
Several clients have requested the entire DME fee schedule for 2025, thinking that all DMEPOS payments are the same nationwide. To satisfy those wishing a specific DMEPOS fee schedule as well as pr...
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Fee Schedules for specific productsposted in Compliance and reimbursement pearls
As most of you know, the DME MAC fee schedule is updated yearly. As opposed to the complex formula of RVU’s for the physician fee schedule, the DME fee schedule is primarlly formulated based ...
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Spiral Rehab AFO’s: Part 1posted in Compliance and reimbursement pearls
A common AFO L1951: Ankle foot orthosis (AFO), spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment has been in the ne...
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Staying a DMEPOS provider worth the costsposted in Compliance and reimbursement pearls
In the face of many DME issues, many ask if continuing as a DMEPOS provider is worth the costs ($709/3 years) and the exposure (audits). Let’s break these discussion points down and p...
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