SUMMARY OF MEDICARE THERAPEUTIC SHOE BILL
Coverage limitations: Medicare will make a partial payment for one pair of qualified footwear per calendar year. What is required: The "certifying physician" (physician who is managing the diabetic condition - MUST be an M.D. or a D.O.) needs to complete the Statement of Certifying Physician for Therapeutic Shoes. A prescription for the footwear must be written by a DIFFERENT physician (D.P.M. other M.D. or Nurse Practitioner are all ok).
The physician needs to have a good understanding about therapeutic shoes and inserts. The footwear must be fitted and furnished by a qualified supplier such as a Board Certified Pedorthist. The conditions requiring the therapeutic shoes may include one or more of the following:
History of partial or complete amputation of the foot, History of previous foot ulceration, History of pre-ulcerative callus, Peripheral neuropathy with evidence of callus formation, Foot deformity or Poor circulation. This information is a guideline only. The source of this information is from Medicare.
INFORMATION ON MEDICARE BENEFIT FOR THERAPEUTIC FOOTWEAR FOR DIABETIC PATIENTS FROM MEDICARE: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 CDC estimated that 67,000 lower limb amputations due to diabetes occur annually - and experts agree that most are preventable with appropriate footwear that is properly fit.
What is Reimbursable: Within a given calendar year, the qualifying patient can receive up to 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.
To Start the Process, Here is What You Need to Do: For a qualified patient to receive this benefit, the certifying physician must complete and sign a "Statement of Certifying Physician for Therapeutic Shoes" and the prescribing physician (a different doctor or nurse practitioner) must complete a footwear prescription. Shane's Foot Comfort Center will then keep the documentation on file and submit the claim to Medicare for traditional Medicare patients.
PLEASE NOTE: Suppliers may not be able to dispense or submit claims for these devices to HMO Medicare patients. WE PROVIDE ALL THE PAPERWORK FOR YOU AND YOUR PHYSICIANS TO COMPLETE. We can submit a claim on your behalf anytime as a courtesy to you. Patient Payment: The patient is responsible for the entire amount and will receive reimbursement directly from Medicare for up to 80% of the amount they designate as allowable for that claim. The Pedorthic Dispenser/Supplier: Many manufacturers make shoes in varying styles and colors that can be termed therapeutic. However, therapeutic footwear is by nature medical, and fitting it to the patient's foot requires special skills and care.
ALL OTHER INSURANCE COVERAGE INFORMATION:
INSURANCE: Insurance coverage for Pedorthic products and services vary. We encourage clients to contact their insurance company to determine what type of coverage is provided for prescription footwear and foot orthoses. Keep in mind that your insurance policy may use certain fee schedules or allowances which may not coincide with our fees. Additionally, benefits given by telephone by your insurance company ARE NOT A GUARANTEE of payment, therefore, it is at the discretion of Shane's Foot Comfort Center, it's contracts with said insurance companies and it's policies to determine how much a client pays at the time of service. At Shane's Foot Comfort Center all amounts charged are usual and customary for the premium products and services we offer. Shane's Foot Comfort Center accepts assignment only as exceptions and may require pre-authorization and/or payment from ANY third party before any supplies may be released.
FEES and PAYMENTS: We provide the best Pedorthic care and services possible. Our fees are reasonable and customary. All fees are due and payable at the time the service(s) and/or device(s) are provided. In addition, Deposits are required on all items, including special order shoes, custom shoes, and foot orthoses that are not being picked up immediately. We accept Visa, MasterCard and Discover.
ADJUSTMENTS: There will be two adjustments at no charge within 60 days after purchase of shoes and/or orthotics. Beginning with the third adjustment, there will be a $10.00 office fee for each adjustment.
OTHER INFORMATION: We are a contracted provider with many insurance carriers. If we have a contract with your carrier we will bill them directly for your Orthotics, you pay out of pocket for any deductibles not yet met or any amount required by your carrier that you are responsible for. Your insurance carrier requires that a prescription from a physician be presented at the time of service to the supplier/ Shane's Foot Comfort Center. If you come in for Orthotics without a prescription, you will be responsible for the full amount due at the time of service, even if you have insurance coverage. Once a prescription is obtained, your insurance may then be billed and you may be reimbursed upon receipt of insurance payment. Shane's Foot Comfort Center only makes and provides PREMIUM products. Your Insurance carrier may not cover PREMIUM products. Therefore, you may be responsible for an amount over and above the "allowed" amount by your insurance company for a certain service or item. ALL balances are due at the time of service unless otherwise specified by insurance benefits or our billing department. Any outstanding balance your insurance carrier does not cover for any reason, is due in full within 30 days of the time of service. ALL patients/clients, with insurance of ANY kind are REQUIRED to fill out and sign a patient registration with an agreement to pay balance in full and HIPPAA regulations (privacy act) form to be kept on file. YES! We are a LABOR and INDUSTRIES (L&I) provider for over 25 years! If you have an L&I claim that is active and open we can provide you with the highest quality services and bill L&I for you. We do work with The CITY OF SEATTLE Programs for police, fire, etc. as well as CENTER FOR THE BLIND, and many other work programs and groups to get your products and services paid for. If you are enrolled in one of these programs please call for an appointment and we will collect all billing information at that time. If you have a special billing need or request please contact our billing department for further information.
Feel free to print THE STATEMENT OF CERTIFYING PHYSICIANíS FORM to get the ball rolling on your Medicare Claim.
206-364-1322
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