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...
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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Hours at time of inspectionposted in Compliance and reimbursement pearls
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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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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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