Shoe reimbursement-replies part 2
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Shoe reimbursement-replies part 2
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We participate in the Therapeutic Shoe program for diabetics since most of
these clients are in our general P&O referral base. The standard by which
all other shoes are measured would be P.W. Minor shoes. They are expensive
however, to use for diabetics on Medicare who need therapeutic shoes. We
will use them if we are not able to get a satisfactory fit with a lower cost
alternative. We use Markell plastazote shoes (specifically their 900 or 901
styles) and Sequoia has a few very workable styles and they are very
attractively priced. Otto Bock did have a really nice imported shoe made in
Italy that was soft and roomy with a full surgical opening with velcro that
worked well with those clients with big, edematous feet and was priced
right. We found out today that they discontinued the item due to lack of
interest. It is a shame because that style was a big help in more that a
few of our problem clients.
I build foot orthoses and fit shoes for people in a shoe retail operation.
That
is the nature of the business, so it gets charged for!
PW Minor appears to be about the most cost effective for us here. We looked
at
Gilbey's too. While they are VERY good, they are just too expensive.
No, we are in Canada. The way that things happen here for such things is
different. There is nothing for footwear like this here. The people who are
on
Welfare go to the Abilities Council (funded by Easter seals), so I don't know
if
they do anything with shoes for them.
Canada
As far as shoes go I will make my comments related to Medicare as most
other
insurance's follow their guidelines.
Aside from the Diabetic foot program and a shoe being attached to a
conventional
metal orthosis, we do not provide the patient with an Orthopedic shoe unless
they are willing to pay retail cash price for the shoe. We have a shoe store
locally we refer the patient to but they have only comfort shoes and no
extra
depth shoes. As for modifications to the shoe, again because medicare does not
recognize modifications to shoes unless attached to an orthosis or the patient
is eligible for the Diabetic foot program, we offer the patient our U/C cost
at
a 20% because it is cash We will let the patient know that this may not be
covered and that they must sign a form indicating such and that they will be
responsible for payment. There is a modifier that is used with the L-code that
indicates that the patient has been informed that this may be denied.
We also participate in the Diabetic foot Program and no longer offer the
patient
a choice of shoes other than color. We find that the average patient can fit
into the Apex Ambulator which costs about $50.00 It appears to be the most
reasonable approach to providing this service. Otherwise the difficult foot
will
be custom molded under the diabetic foot program and we will use our local
shoe
man to fabricate this item.
As far as profitable.... We do ok but of course it is far from
desirable, as
those with problem feet need F/U and that is were we loose any gains
economically. We probably have 1 in 10 patients that really need to have
intense
F/U. This is our opportunity to be good Samaritans to the community and eat
any
loss.
I have on occasion offered the diabetic shoe program format to the non
diabetic
patient for what Medicare allows if it seems fairly simple and the patient
can't
afford the PW Minor shoe. I have to anticipate how involved the patient might
become and will not offer the diabetic shoe option if it is not appropriate.
We
have found that Comfort Rite/Sequoia in Wisconsin has a few shoes that can be
provided fairly reasonably and can also be used with the Diabetic Foot
Program.
But to keep thing simple and prevent us from being shoe salespersons....We
expedite decisions by offering only a choice of colors and velcro or lace
closures.
Write it off. No way. If at all possible we want to avoid that. I
believe that
we can provide a very basic program without spending alot of time and still
make
a little money.
Thanks for your great questions. I know that we all are having to deal
with
these dilemmas and try to continue our services to the community without
becoming indentured servants.
Recently I decided to stop doing CMS's because of the hassle and minimal
reimbursement. Fortunately it is not a big part of my practice but it is not
worth the effort. I don't think it is a break even personally.
We are losing our you know whats on shoes. I would suggest Urban Walkers by
ACOR. I think they are called Active Walkers now. . Or Easy Streets . I also
urge people to buy their own shoes and I fit them with inserts only when
possible. Hope this helps.
A) We normally break even when we provide shoes, unless they are a mismate
pair. We then make it clear to the consumer that they will be responsible
for the additional cost for the second pair of shoes required to fit them.
B) Apex Ambulators are the best for the money diabetic shoes we can find.
C) Yes. We participate with Medicare's diabetic shoe program as a
courtesy to our customers. With the 3 sets of inserts allowed by medicare,
we normally make a decent profit, though by no means anywhere near jumping
for joy about. We do make the necessary adjustments at no additional charge
to the inserts as required, to alleviate pressure and avoid any ulcers.
This may have to end as a 'free' service to our customers though, as
medicare continues to increase our costs by piling more and more paperwork
on us to participate.
wish they would quit tripping over dollars trying to pick up nickles.
Hope that helps you out with your research.
these clients are in our general P&O referral base. The standard by which
all other shoes are measured would be P.W. Minor shoes. They are expensive
however, to use for diabetics on Medicare who need therapeutic shoes. We
will use them if we are not able to get a satisfactory fit with a lower cost
alternative. We use Markell plastazote shoes (specifically their 900 or 901
styles) and Sequoia has a few very workable styles and they are very
attractively priced. Otto Bock did have a really nice imported shoe made in
Italy that was soft and roomy with a full surgical opening with velcro that
worked well with those clients with big, edematous feet and was priced
right. We found out today that they discontinued the item due to lack of
interest. It is a shame because that style was a big help in more that a
few of our problem clients.
I build foot orthoses and fit shoes for people in a shoe retail operation.
That
is the nature of the business, so it gets charged for!
PW Minor appears to be about the most cost effective for us here. We looked
at
Gilbey's too. While they are VERY good, they are just too expensive.
No, we are in Canada. The way that things happen here for such things is
different. There is nothing for footwear like this here. The people who are
on
Welfare go to the Abilities Council (funded by Easter seals), so I don't know
if
they do anything with shoes for them.
Canada
As far as shoes go I will make my comments related to Medicare as most
other
insurance's follow their guidelines.
Aside from the Diabetic foot program and a shoe being attached to a
conventional
metal orthosis, we do not provide the patient with an Orthopedic shoe unless
they are willing to pay retail cash price for the shoe. We have a shoe store
locally we refer the patient to but they have only comfort shoes and no
extra
depth shoes. As for modifications to the shoe, again because medicare does not
recognize modifications to shoes unless attached to an orthosis or the patient
is eligible for the Diabetic foot program, we offer the patient our U/C cost
at
a 20% because it is cash We will let the patient know that this may not be
covered and that they must sign a form indicating such and that they will be
responsible for payment. There is a modifier that is used with the L-code that
indicates that the patient has been informed that this may be denied.
We also participate in the Diabetic foot Program and no longer offer the
patient
a choice of shoes other than color. We find that the average patient can fit
into the Apex Ambulator which costs about $50.00 It appears to be the most
reasonable approach to providing this service. Otherwise the difficult foot
will
be custom molded under the diabetic foot program and we will use our local
shoe
man to fabricate this item.
As far as profitable.... We do ok but of course it is far from
desirable, as
those with problem feet need F/U and that is were we loose any gains
economically. We probably have 1 in 10 patients that really need to have
intense
F/U. This is our opportunity to be good Samaritans to the community and eat
any
loss.
I have on occasion offered the diabetic shoe program format to the non
diabetic
patient for what Medicare allows if it seems fairly simple and the patient
can't
afford the PW Minor shoe. I have to anticipate how involved the patient might
become and will not offer the diabetic shoe option if it is not appropriate.
We
have found that Comfort Rite/Sequoia in Wisconsin has a few shoes that can be
provided fairly reasonably and can also be used with the Diabetic Foot
Program.
But to keep thing simple and prevent us from being shoe salespersons....We
expedite decisions by offering only a choice of colors and velcro or lace
closures.
Write it off. No way. If at all possible we want to avoid that. I
believe that
we can provide a very basic program without spending alot of time and still
make
a little money.
Thanks for your great questions. I know that we all are having to deal
with
these dilemmas and try to continue our services to the community without
becoming indentured servants.
Recently I decided to stop doing CMS's because of the hassle and minimal
reimbursement. Fortunately it is not a big part of my practice but it is not
worth the effort. I don't think it is a break even personally.
We are losing our you know whats on shoes. I would suggest Urban Walkers by
ACOR. I think they are called Active Walkers now. . Or Easy Streets . I also
urge people to buy their own shoes and I fit them with inserts only when
possible. Hope this helps.
A) We normally break even when we provide shoes, unless they are a mismate
pair. We then make it clear to the consumer that they will be responsible
for the additional cost for the second pair of shoes required to fit them.
B) Apex Ambulators are the best for the money diabetic shoes we can find.
C) Yes. We participate with Medicare's diabetic shoe program as a
courtesy to our customers. With the 3 sets of inserts allowed by medicare,
we normally make a decent profit, though by no means anywhere near jumping
for joy about. We do make the necessary adjustments at no additional charge
to the inserts as required, to alleviate pressure and avoid any ulcers.
This may have to end as a 'free' service to our customers though, as
medicare continues to increase our costs by piling more and more paperwork
on us to participate.
wish they would quit tripping over dollars trying to pick up nickles.
Hope that helps you out with your research.
Citation
“Shoe reimbursement-replies part 2,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 27, 2024, https://library.drfop.org/items/show/215037.
