2) Develop a certificate of medical necessity that is thorough, easy to read and easy to sign.
Before you can bill Medicare or Medicaid for shoes, you must provide this CMN. Be sure to check state regulations. Medicare will accept Medicaid-approved CMNs, but Medicaid will not always accept Medicare’s recommended CMN. 3) Select the shoes you wish to carry (see “What Kind Of Shoes Should You Offer?” below) and then contact those companies for a display packet.
There may be a cost involved, but having sample shoes and educational literature in your office is well worth the investment. 4) Get the word out.
Let your diabetic patients know you are now a certified supplier of diabetic shoes. Educate the primary care doctors in your area regarding the benefits of therapeutic shoes. Purchase a mailing list from the American Diabetes Association of diabetics in your area. Use your traditional media outlets such as newspaper ads and radio. However, don’t go overboard as you want to avoid being perceived as more of a salesperson than a doctor. Get your staff involved. Remember, a “shoe-informed” back office assistant will make a huge difference in the success of this program. Make Your CMN Stand Out The CMN form is critical for your success in the diabetic shoe program. Despite that fact that your patient’s primary doctor may not have looked at your patient’s feet in 20 years, he or she can still refuse to sign the form. If the primary doctor is well educated and well informed about risk factors among diabetic patients, he or she will gladly sign it. Here are some things you must convey to your referring primary doctors about diabetic shoes. • Let them know you are doing an actual diabetic exam on these patients to determine if they qualify for shoes. Pharmacies, DME companies, etc., do not do diabetic foot examinations. • Write down or call and tell the doctor the results of your exam. • Make the primary doctor aware of the components of the diabetic shoe. Emphasize for example that the shoe is an extra-depth shoe with a multilaminar insole. Also make sure the PCP is aware that you are not dispensing a $20 shoe. • Let the signing doctor know that the patient is involved in your unique comprehensive diabetic foot program that includes diabetic shoes. Make him or her aware that you will be following up with the patients to see if the shoes you dispensed are accomplishing the desired effect. • Develop a risk classification for your patients that will allow the signing physician to know what diabetic risk category the patient is in. The University of Texas diabetic foot risk classification is perfect for this. (See http://www.diabeticfoot.org/Research.html#Anchor-The-11481
.) • Make your CMN unique to your practice. Put some handwritten notes on your CMN or insert some information on how proper shoes can lower the risk of amputation. Whatever you do, make sure your CMN looks professional and ensure that it does not look a pharmacy or DME company CMN. Pointers For Measuring And Ensuring A Proper Fit Currently, more diabetic shoes are being dispensed from “medical supply (DME)” stores than out of podiatric offices. Why? Prescribing DPMs certainly know more about the foot and diabetic risk factors than any pedorthist or physical therapist. Much of what is involved in fitting and molding patients for shoes is common sense. Here are some considerations. • Measure right the first time. The first thing you need to have is an accurate measuring device. Some diabetic shoe companies have their own specific measuring tools for their shoes so it’s important to measure correctly for the prescribed shoe. When measuring the patient, be sure to measure both feet as sizes may differ. Measure the width of the foot and be aware and educated as to what shoe types come in the wider widths. Avoid putting a patient with a 4E width into an “extra wide shoe.” Some shoes only go up to an extra wide width while others (like the New Balance 810) go up to a 4E width. Include the size and width on your prescription along with your recommended shoe. Most vendors will send you information or will even send a rep to your office to educate you on how to appropriately and accurately measure for shoes. Don’t be afraid to ask. • When the patient comes in for fitting, it is well worth your time to make sure the shoe fits his or her foot well.