medicare= no more podiatry?

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Temple1st

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Eric, what in the world does the new APMA email mean:

In the article, CMS first noted that Medicare does not cover so-called "routine" foot care such as the cutting or removal of corns and calluses, the trimming, cutting, clipping, or debriding of nails, and other hygienic and preventive maintenance care such as cleaning and soaking the foot, use of skin creams to maintain skin tone of either ambulatory or bedfast patients, and any other service performed in the absence of localized illness, injury, or symptoms involving the foot.

Correct me if I'm wrong but this is over half of our income.

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I'm not sure how well, or if I can answer your question. I don't have any experience in billing, or in specifics of practice management. I'll give you my limited thoughts on this though.

I doubt your last statement about this being half our income is accurate. Maybe for some, but not for all.

I think it would be premature to make any comments about this being the death of podiatry. I'm sure you can find some doom and gloom types saying this though. I highly doubt it, though it may affect some people more than others, and for some it might be more of a problem than for others.

The makeup of practices varies greatly, and so do the patient populations. Some of my classmates have said that in their hometowns most of this type of care was done on a cash basis. If it is not covered by Medicare or insurance but people want it, they will pay out of pocket. For other practices, the "routine" footcare makes up a negligible part of their income. And I am sure that others make a majority of thier income from these patients.

I would also hesitate to say how it would affect things, because of the wording. This may not be covered in the absence of other factors. If the patient is diabetic, and has CAD, PVD, neuropathy and the potential for developing an ulcer it will probably still be covered. And this might fit a fairly high number of the patients.

So, I would be hesitant to say that it is going to be a major problem. Others may have different views. ToeJam is probably in a better position to comment on this than I am.

Hope this helps.
 
Medicare and Medicaid have specific guidelines as to what qualifies as "medically necessary". When they talk about routine foot care, it generally means calluses, which are not intractable plantar keratoses (the ones that have a plug in the center that feels like a pebble) and toenails, which are not thick enough to cause pain inside shoes. Routine foot care, therefore, refers to simple calluses and non-painful toenails.

You can bill for routine foot care if the patient is somehow medically compromised (which you have to prove in your documentation). Examples of this would be peripheral vascular disease, peripheral neuropathy, inability to cut their own nails because of arthritis, etc.

As far as I know, most podiatrists push the envelope on these rules. It's doubtful that they will follow this to the letter because, otherwise, they wouldn't have enough patients. These rules revolve around the risk of being audited, which in turn is dependent on your documentation and the normal standards of billing in your area (like are you billing way to many wedge resections compared with other practitioners in your city).

In my opinion, however, Medicare is slowly making it more and more difficult to earn money from nail and callus debridement. They are well aware that millions of dollars are being reimbursed to doctors who are not telling the truth or who are just flat out comitting fraud.
 
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