Therapeutic Shoes for Persons with Diabetes—Prepayment Review Update
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Therapeutic Shoes for Persons with Diabetes—Prepayment Review Update
 
As you know, the National Government Services, Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Medical Review Department recently conducted a prepayment targeted medical review of therapeutic shoes for persons with diabetes.  This is a widespread random selection of submitted claims based on a targeted service(s) from multiple suppliers which are reviewed for medical necessity.

Nine suppliers were involved in this review, 88 claims were reviewed and 19 claims were allowed as billed. The remaining claims were denied for one or more of the reasons listed below.

denial reason Number of Claims denied
No/insufficient medical record documentation of a qualifying foot condition 51
No/insufficient medical record documentation of the management of diabetes 25
Invalid detailed written order 22
No documentation received 11
Invalid Statement of the Certifying Physician 4
Insufficient information regarding the coding of inserts 4

 

It is important for suppliers to be familiar with the documentation requirements and utilization parameters as outlined in the Local Coverage Determination for Therapeutic Shoes for Persons with Diabetes and Policy Article for Therapeutic Shoes for Persons with Diabetes.  When submitting information pertaining to additional documentation requests, please ensure that all supporting medical necessity documentation is providedin a timely manner.

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