Updated: Oct 19, 2020
Getting back to all the fun insurance requirements, let's start with one of the more complicated processes for Medicare and Medicare Replacement plans!
One of the most frustrating situations is getting diabetic shoes and inserts. It's extremely important that the devices are in good condition to prevent any skin breakdown. Shoes and inserts, seem easy enough, right? Medicare has enacted a Therapeutic Shoe Policy (A47129) as an attempt to reduce the amount of fraudulent claims.
As a provider of diabetic shoes and inserts for patients with Medicare/Medicare Replacement plans, we are required to collect and provide medical documentation from the "Certifying Physician," (MD or DO) that shows proof that their diabetes is being monitored/managed regularly.
The notes showing proof of diabetic management must come from a MD or DO only, (no NP, PA, CNP or DPMs). Proof of diabetic management includes things like A1C counts, blood pressure, cholesterol and triglyceride levels. There must also be a complete foot exam done by any provider but will need to be co-signed by your MD/DO who treats the diabetes.
Diabetic management (care plan) notes from in-person appointment - MD/DO only, co-signature not accepted, must reference the same information as the Statement of Certifying Physician, cannot be older than 6 months from delivery date.
Diabetic foot exam notes from in-person appointment - Can still be co-signed by MD/DO if performed by a NP, PA, CNP or DPM. Cannot be older than 6 months from delivery date.
Statement of Certifying Physician Form - MD/DO only (cannot be dated after the Diabetic management notes), cannot be older than 3 months from delivery date.
Phew. There is no easy way to teach this information because there is so much. Hopefully this post can help everyone understand the rules and appreciate the complicated matter of getting all of the proper documentation!