Inspect your feet every day, and seek care early if you do get a foot injury. Make sure your health care provider checks your feet at least once a year - more often if you have foot problems. Your health care provider should also give you a list and explain the do's and don'ts of foot care. Most people can prevent any serious foot problem by following some simple steps. So let's begin taking care of your feet today.

 

Prevention

Your health care provider should perform a complete foot exam at least annually - more often if you have foot problems.

Remember to take off your socks and shoes while you wait for your physical examination.

Call or see your health care provider if you have cuts or breaks in the skin, or have an ingrown nail. Also, tell your health care provider if your foot changes color, shape, or just feels different (for example, becomes less sensitive or hurts).

If you have corns or calluses, your health care provider can trim them for you. Your health care provider can also trim your toenails if you cannot do so safely.

Because people with diabetes are more prone to foot problems, a foot care specialist may be on your health care team.

Caring for Your Feet

There are many things you can do to keep your feet healthy.

1. Take care of your diabetes. Work with your health care team to keep your blood glucose in your target range.
2. Check your feet every day. Look at your bare feet for red spots, cuts, swelling, and blisters. If you cannot see the bottoms of your feet, use a mirror or ask someone for help.
3. Be more active. Plan your physical activity program with your health team.
4. Ask your doctor about Medicare coverage for special shoes.
5. Wash your feet every day. Dry them carefully, especially between the toes.
6. Keep your skin soft and smooth. Rub a thin coat of skin lotion over the tops and bottoms of your feet, but not between your toes.
7. If you can see and reach your toenails, trim them when needed. Trim your toenails straight across and file the edges with an emery board or nail file.
8. Wear shoes and socks at all times. Never walk barefoot. Wear comfortable shoes that fit well and protect your feet. Check inside your shoes before wearing them. Make sure the lining is smooth and there are no objects inside.
9. Protect your feet from hot and cold. Wear shoes at the beach or on hot pavement. Don't put your feet into hot water. Test water before putting your feet in it just as you would before bathing a baby. Never use hot water bottles, heating pads, or electric blankets. You can burn your feet without realizing it.
10. Keep the blood flowing to your feet. Put your feet up when sitting. Wiggle your toes and move your ankles up and down for 5 minutes, two (2) or three (3) times a day. Don't cross your legs for long periods of time. Don't smoke.
11. Get started now. Begin taking good care of your feet today.  Set a time every day to check your feet.

PATIENT INFORMATION ON MEDICARE BENEFIT FORTHERAPEUTIC FOOTWEAR FOR DIABETICS

According to the American Diabetes Association, there are approximately 32 million Americans with diabetes. Unfortunately, this number continues to grow. 35 percent of persons with diabetes develop foot problems related to the disease. Recognizing this problem, Congress approved the Medicare Therapeutic Shoe Bill, helping thousands of persons with diabetes obtain protective footwear and inserts.

 

In May 1993, Congress amended Medicare statutes to provide partial reimbursement for depth shoes, custom molded shoes, and shoe inserts or modifications to qualifying Medicare Part B patients with diabetes. The Centers for Disease Control has estimated that 86,000 lower limb amputations due to diabetes occur annually – and experts agree that most are preventable with appropriate footwear that is properly fit.

How Patients Qualify

The physician (M.D. or D.O.) who manages the patient's systemic diabetic condition is called the certifying physician.  The certifying physician must state (see form below) that the patient has diabetes mellitus, has one or more of the conditions which Medicare describes as placing the patient at risk, is being treated under a comprehensive plan of care for his/her diabetes and needs therapeutic shoes and/or inserts because of the diabetes.  

Documentation Requirements

Medicare program carriers generally require the following before reimbursement will be made for shoes, inserts or modifications furnished to a program beneficiary.
A certification of medical necessity from the physician who manages the patient's diabetes, which certifies that the patient:
(a) has diabetes mellitus,
(b) has at least one of the qualifying conditions,
(c) is being treated under a comprehensive plan of care for his or her diabetes, and
(d) needs diabetic shoes.

Medicare carriers recommend that suppliers use the Medicare approved “Statement of Certifying Physician for Therapeutic Shoes” form to fulfill this requirement.

A prescription for a particular type of footwear (e.g., shoes, inserts, modifications) from a podiatrist, or physician who is knowledgeable in the fitting of diabetic shoes and inserts. Suppliers are required to keep file copies of signed and dated physician prescriptions.

What is Reimbursable

Within a given calendar year, the qualifying patient can receive 80% of the allowed amounts for one pair of depth shoes and three pairs of inserts OR one pair of custom molded shoes (including inserts) and two additional pairs of inserts.  Also: 1) shoe modifications can be substituted for an insert; and 2) custom molded shoes are only covered when the patient has a foot deformity that cannot be accommodated by a depth shoe.

 

To Start the Process, Here Is What You Need to Do

For a qualified patient to receive this benefit, the certifying physician (M.D. or D.O.) must review and sign a "Statement of Certifying Physician for Therapeutic Shoes" and the prescribing physician (D.P.M., M.D. or D.O.) must complete an appropriate prescription prior to the dispensing of the devices.  The patient can see a qualified pedorthist, orthotist, prosthetist, or podiatrist to have the prescription filled. The supplier will then keep the documentation on file and submit the claim to Medicare for traditional fee-for-service Medicare patients.   PLEASE NOTE:  Suppliers may not be able to dispense or submit claims for these devices to Medicare patients enrolled in Medicare + Choice (HMO-type) healthcare plans.

Patient Payment

The Centers for Medicare & Medicaid Services ([CMS], formerly known as Health Care Financing Administration [HCFA]) will reimburse 80% of the amount it designates as “allowable,” with the patient responsible for paying the dispenser/supplier a minimum of 20% of the total payment amount. If the Medicare supplier does not accept assignment of the claim, the patient is responsible for the entire amount and will receive reimbursement directly from Medicare for 80% of the allowable amount.   PLEASE NOTE: Some Medicare suppliers may not accept assignment if the allowable amount is too low to cover the appropriate materials and services. In these situations, the total cost to the patient may be higher than the allowable amount. If so, the patient is usually expected to pay the Medicare supplier in full before he or she receives reimbursement from Medicare.

Furnishing The Footwear

The footwear must be fitted and furnished by a podiatrist or other qualified individual, such as a pedorthist, orthotist, or prosthetist. The certifying physician may not furnish the footwear unless he or she practices in a defined rural area or health professional shortage area. Only then, the prescribing physician may be the supplier.

Additional Requirements

Additional requirements may apply. You should consult a qualified expert or Medicare for more information. 

CMS MEDICARE DMEPOS SUPPLIER STANDARDS

1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.
2. A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.
3. An authorized individual must sign the application for billing privileges.
4. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or non-procurement programs.
5. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.
6. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare covered items that are under warranty.
7. A supplier must maintain a physical facility on an appropriate site.
8. A supplier must permit CMS (formerly HCFA), or its agents to conduct on-site inspections to ascertain the supplier’s compliance with these standards. The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.
9. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine or cell phone is prohibited.
10. A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier’s place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations.
11. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from calling beneficiaries in order to solicit new business.
12. A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare covered items, and maintain proof of delivery.
13. A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.
14. A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.
15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.
16. A supplier must disclose these supplier standards to each Medicare beneficiary.
17. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.
18. A supplier must not convey or reassign a supplier number; i.e., the supplier may not sell or allow another entity to use its Medicare billing number.
19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.
20. Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.
21. A supplier must agree to furnish CMS (formerly HCFA) any information required by the Medicare statute and implementing regulations.

 

 

 

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