The process of selling, fitting, delivering, billing, and collecting reimbursements for therapeutic shoes and inserts follow a similar process as with most DME products.  Below, we take you through each of the steps along with estimates for billing and reimbursements.

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Who Qualifies?

In order for a patient to qualify under Medicare guidelines for therapeutic shoes and inserts the following criteria must be met:

1)  The patient has diabetes mellitus (ICD-9 diagnosis codes 250.00-250.93), is eligible for Medicare benefits; and

2)  The patient has one or more of the following conditions:

If a patient is qualified, they may receive the following items:

• 1 pair of Therapeutic shoes (per calendar year)
   
• 3 pairs of Inserts - Custom or Pre-fab (per calendar year)
   

Doctors - Prescription (Rx)

Upon patient qualification and before placing an order, it is necessary to receive the approval from the patient's primary diabetes Doctor.  The Prescription is sent or faxed to the Dr. for their signature.  The Medicare guidelines state:

The certifying physician who is managing the patient's systemic diabetes condition has certified that indications (1) and (2) above are met and that he/she is treating the patient under a comprehensive plan of care for his/her diabetes and that the patient needs diabetic shoes.

Patient's authorization to bill Medicare

The standard patient authorization form needs to be signed by the patient and returned prior to billing Medicare. 

Billing Medicare & Supplemental Insurance

Upon completion and certification that the therapeutic shoes and inserts have been delivered and accepted by the patient, the Medicare Provider company then bills Medicare, Supplemental Insurance, and possibly the patient for the co-pay amount.

Below is a schedule that shows the approximate Medicare billing amounts and reimbursements:

 

Certification & Training

Providing Diabetic Shoes is a great way to lead in your marketing efforts.  Diabetic shoes provide excellent margins and recurring revenue while opening the door for other patient needs.  Leading with Diabetic shoes is an affective method of attracting new patients.

Qualifications:

Diabetic Shoes - There are specific Medicare education / certification qualifications required to provide diabetic shoes.  In most of the states the only requirement is to have a Manufacturers Certificate.  The other states may require the fitter to be a Pedorthist, Orthotic Fitter, Doctor, and specific professionals - these states will not accept a Manufacturers certificate.  If you are considering providing shoes,  call Medicare and determine the requirements in your state.

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