Real life experiences often necessitate one look at the very basics and essence of one’s occupation. Orthotic coding is no exception. A recent social engagement with other podiatrists sent a ...
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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Back to Basics Coding Compliance for Foot Orthotics - Part 1posted in Compliance and reimbursement pearls
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K Modifierposted in Compliance and reimbursement pearls
This week’s column answers a question from a reader: "I recently billed for a L5020 Tibial tuberosity toe filler. Despite obtaining pre-authorization from the carrier, the claim was rejected...
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PECOS Issuesposted in Compliance and reimbursement pearls
Hopefully, this will be the last article on enrollment for a while. My own recent personal experience with Medicare and PECOS AKA Provider Enrollment, Chain and Ownership System, is the subject for...
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CMS Launches Yet Another Reason for Providers To Take Enrollment Seriouslyposted in Compliance and reimbursement pearls
On the heels of all the DME enrollment segments, CMS has announced several new, potentially more powerful penalties which may affect all providers, not just DME providers. Simply put, these...
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A5512 vs A5513 or A5514posted in Compliance and reimbursement pearls
This is a continuation of the past week’s discussion on whether there is a bell curve one should adhere to for determining which type insert (heat or custom) to provide to a specific ...
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A5512 vs A5514posted in Compliance and reimbursement pearls
A colleague recently asked a question regarding the existence of a bell curve by which the DME MAC might compare their practice to others regarding heat molded vs custom therapeutic inserts...
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AFO not in scopeposted in Compliance and reimbursement pearls
A colleague recently contacted me that a state carrier denied his claim for an AFO because it was out of scope. He requested some information on how to respond. With the limite...
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60K lost due to non complaince with reenrollmentposted in Compliance and reimbursement pearls
It’s truly amazing how the real world of DME enrollment tragedies continues, this despite the increased warnings posted in many published articles on this subject. This past wee...
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When Medicare Says You Didn’t Write an Order to Yourselfposted in Compliance and reimbursement pearls
The other day, a physician who is also a certified coder called me with a Medicare audit problem that had him stumped. His AFO claim had been denied because the DME MAC stated there was no...
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The Orthopedic Surgeon Who Went to Prison Over an Enrollment Formposted in Compliance and reimbursement pearls
An Orthopedic Surgeon Went to Prison Over a Medicare Enrollment Form. Seriously. Most doctors worry about audits, denials, and prior authorizations. Few worry that a Medicare enrollment form coul...
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CEDI Front-End Rejections: Common Errors and Simple Fixesposted in Compliance and reimbursement pearls
Every month the Common Electronic Data Interchange (CEDI) which electronically processes your DME claims, provides a list of the most common reasons why an electronic claim is rejected. This even b...
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When Same and Similar Meets Wedding Planningposted in Compliance and reimbursement pearls
Not much has changed since this column began about the issue of Same and/or Similar. To provide a bit of Levity about this daunting subject I took an old joke and put a bit of a spin to it. ...
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Patients Status Post TMA: Addressing More Advanced Biomechanical Needsposted in Compliance and reimbursement pearls
The first installment addressing the biomechanical needs of patients’ status post trans metatarsal amputation (TMA) reviewed the major biomechanical challenges these patients face and initial...
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Trans Metatarsal Amputation (TMA)posted in Compliance and reimbursement pearls
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...
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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...
