We are very sorry that the patient was so unhappy with our services I would like to address the patient’s complaints that lead up to Medicare not approving her shoes and inserts · Referred to Upstate Pedorthic Services from Steadman Hawkins on our RX pads so patient has map, address and phone number of our location · ** Medicare requirement have changed o In the past Medicare required only a certifying statement completed by the doctor treating the diabetic condition About a year and half ago requirement changed to include office notes from the same doctor These notes must be very detailed to specify the need for diabetic shoes and match the condition addressed on the certifying statement · [redacted] Employee working certifying statement received patient chart and called her on 8/11/patent said she received certifying statement at her first appointment “per our protocol” and she has an appointment with her endocrinologist doctor on 8/16/ · ** All note below are notes in patient charts of employee working account o 8/24/received notes/CS from endocrinologist doctor o 8/27/we faxed over request for addendum of feet or foot assessment form to be completed (per Medicare requirements) o 9/3/Patient upset it is taking so long – we offered a new program Medicare is allowing a test claim (not a real claim)Practice sends in all doctor notes and RX, Medicare reviews and inform by letter if would be a charged by their guidelineso 09/14/Patient endocrinologist doctor left message explained he does not sign these forms Upstate tried to return called, having to leave message that this is Medicare requirements to cover patient’s shoes and insertso 9/04/Called patient explained we are still waiting on Medicare reply from testo 09/10/patient called upset no reply from Medicare We called Medicare and was told we have to wait on letter from Medicare, informed patient o 9/17/Patient called very upset we do not have an answer yet Also patient doctor called left message, will not do foot assessment form that her podiatrist should do that We tried to return MD’s call but no luck, left message with nurse We did fax over sheet of Medicare requirements to nurse Patient said she would call Medicare and get some answerso 9/18/Medicare called me on a way call Medicare would not have called Upstate Pedorthic Services if we are not a providerI’m not sure why one of patient’s complaints was we are not a providerUpstate Pedorthic Services have been a provider with Medicare for + years I explained the test that Medicare was offering and we were waiting on reply and that we were unsure if Medicare would cover with the notes we were provided After talking to the Medicare Rep we agreed patient could sign an ABN and we could start the process of her shoes Patient was very upset she was not offered that before I explained we do not offer this because Per Medicare we cannot use this as a blanket to all patients The patient needs to understand that if Medicare does not cover items she will be responsible She understood and wanted us to start the processes · [redacted] I went to order patient shoe the next day and the shoe had been discontinued Called patient and she told me what she needed I talked to the Pedorthist within the next day or two and we ordered the shoe · [redacted] 9/25/received letter from Medicare that they denied test – the reason below is what the office was questioning o Clinical notes do not document the presence of one or more conditions on the certifying statement o Patient was called and told the results, as a result of test patient wanted her RX returned o I mailed her Certifying statement and MD notes to her · [redacted] Shoes could not be cancelled as they were in transit and when they arrived employee did not pull chart and by mistake called patient to inform her shoe were in This was a mistake I talked to patient and apologized for calling, she then asked me to mail her original RX I apologized again for not sending it the first time I thought I sent everything She was upset RX was on Upstate Pedorthic Service pad I apologized again saying this helps patient know where to go for services I am very sorry for all the rules and guidelines Medicare has Upstate Pedorthic Services tries our best to follow the rules and we know it can be very frustrating for the patients and doctors I don’t understand why patient thinks she was lied to As you can see we document in her chart very well all that took places Patient did not want items when told Medicare denied test With the information we have shoe and inserts would be self-pay At this time we are unable to go further to help this patient Sincerely [redacted] / [redacted] Style Definitions */
The majority of our patients are referred to us from Orthopedist, Podiatrist, Rheumatologists, Wound Care Centers and other doctor that treat foot conditionsThat is why patients are given the diabetic packet that includes all of the required documents needed by Medicare to file a claimThe packet was given and explained to patient as noted in first letterMedicare requires that the doctor that treats a patient’s diabetes is the only physician that can complete the certifying statementIn addition that physician must perform a foot examination and dictate into the patients chart the findingsAgain this is a Medicare requirement, not an Upstate Pedorthic requirementThe first five calls to or from patient [redacted] , who along with her husband, the Pedorthist owns Upstate Pedorthic ServicesMrs [redacted] was concern that there was insufficient documentation for this claim to be approved by MedicareMrs [redacted] came to me and asked my opinion and I felt like, after working with new requirement from Medicare for the past year and a half it was unlikely they would cover for shoes and inserts with the documentation we haveAbout that same time Medicare offered a way to send in documentation (not claim) to determine if patient’s inserts and shoes would be coveredThe information we received about program stated we would receive reply by mail within daysWe were only given a fax number for communication for this programPer Medicare rules we cannot bill Medicare until patient has received their shoes and insertsMrs [redacted] explained to patient that if we filed a real claim and it was denied she would become responsible for paymentIt is our policy to protect our patients from unexpected cost by trying all the means at our disposal to assure claims would be coveredMrs [redacted] explained to patient in a phone conversation about program Exactly ten days after the documentation was faxed patient called office spoke to Mrs [redacted] and was very upset we had not received a replyMrs [redacted] explained this was a new program and asked [redacted] to call Medicare for status As I previously stated in last letter, Medicare said we had to wait on letter There was no way to contact that departmentPatient was very upset that we had said days and Mrs [redacted] explained we were giving her the information that Medicare had given to us about this programThis program is a Medicare program, the denial letter is on Medicare letterheadThe next day the patient contacted Medicare who then called me on a way callFirst Medicare said shoes and inserts are a covered services and I replied to Medicare rep that the information is correct, they are covered as long as the provider, in this case Upstate Pedorthic Services, has all the documentation requiredI went on to tell the Medicare rep where to find Medicare guidelines on Medicare’s website and she agreed That is when I explained what an ABN is, which is a form patient can sign if items are not covered by MedicareWe cannot give this form to diabetic patients to sign until we have confirmed or expect they do not meet Medicare guidelinesIt is Upstate Pedorthic Services desire to provided needed shoes and insets for our patients, but to also protect them from a significant cost We are very sorry that patient has been so dissatisfiedThankfully patient’s chart is well documented of all that took place and our office staff in trying to assets patient and her providerWe cannot make any provider sign forms or perform foot exams for Medicare requirementsWe have been in business for years and our goal has always been to give the best care to our patients This patient NEVER received any inserts or shoes from usIn addition we have spent countless man hours trying to help this patient get items above covered by MedicareWe also ordered shoes and had to return them, which cost us money for the shipping back and forth to the manufactureThis entire event is because the patient’s physician that treats her diabetes refused to do a foot examinationWe have dismissed this patient and will not provide any services / [redacted] Style Definitions */
We are very sorry that the patient was so unhappy with our services I would like to address the patient’s complaints that lead up to Medicare not approving her shoes and inserts · Referred to Upstate Pedorthic Services from Steadman Hawkins on our RX pads so patient has map, address and phone number of our location · ** Medicare requirement have changed o In the past Medicare required only a certifying statement completed by the doctor treating the diabetic condition About a year and half ago requirement changed to include office notes from the same doctor These notes must be very detailed to specify the need for diabetic shoes and match the condition addressed on the certifying statement · [redacted] Employee working certifying statement received patient chart and called her on 8/11/patent said she received certifying statement at her first appointment “per our protocol” and she has an appointment with her endocrinologist doctor on 8/16/ · ** All note below are notes in patient charts of employee working account o 8/24/received notes/CS from endocrinologist doctor o 8/27/we faxed over request for addendum of feet or foot assessment form to be completed (per Medicare requirements) o 9/3/Patient upset it is taking so long – we offered a new program Medicare is allowing a test claim (not a real claim)Practice sends in all doctor notes and RX, Medicare reviews and inform by letter if would be a charged by their guidelineso 09/14/Patient endocrinologist doctor left message explained he does not sign these forms Upstate tried to return called, having to leave message that this is Medicare requirements to cover patient’s shoes and insertso 9/04/Called patient explained we are still waiting on Medicare reply from testo 09/10/patient called upset no reply from Medicare We called Medicare and was told we have to wait on letter from Medicare, informed patient o 9/17/Patient called very upset we do not have an answer yet Also patient doctor called left message, will not do foot assessment form that her podiatrist should do that We tried to return MD’s call but no luck, left message with nurse We did fax over sheet of Medicare requirements to nurse Patient said she would call Medicare and get some answerso 9/18/Medicare called me on a way call Medicare would not have called Upstate Pedorthic Services if we are not a providerI’m not sure why one of patient’s complaints was we are not a providerUpstate Pedorthic Services have been a provider with Medicare for + years I explained the test that Medicare was offering and we were waiting on reply and that we were unsure if Medicare would cover with the notes we were provided After talking to the Medicare Rep we agreed patient could sign an ABN and we could start the process of her shoes Patient was very upset she was not offered that before I explained we do not offer this because Per Medicare we cannot use this as a blanket to all patients The patient needs to understand that if Medicare does not cover items she will be responsible She understood and wanted us to start the processes · [redacted] I went to order patient shoe the next day and the shoe had been discontinued Called patient and she told me what she needed I talked to the Pedorthist within the next day or two and we ordered the shoe · [redacted] 9/25/received letter from Medicare that they denied test – the reason below is what the office was questioning o Clinical notes do not document the presence of one or more conditions on the certifying statement o Patient was called and told the results, as a result of test patient wanted her RX returned o I mailed her Certifying statement and MD notes to her · [redacted] Shoes could not be cancelled as they were in transit and when they arrived employee did not pull chart and by mistake called patient to inform her shoe were in This was a mistake I talked to patient and apologized for calling, she then asked me to mail her original RX I apologized again for not sending it the first time I thought I sent everything She was upset RX was on Upstate Pedorthic Service pad I apologized again saying this helps patient know where to go for services I am very sorry for all the rules and guidelines Medicare has Upstate Pedorthic Services tries our best to follow the rules and we know it can be very frustrating for the patients and doctors I don’t understand why patient thinks she was lied to As you can see we document in her chart very well all that took places Patient did not want items when told Medicare denied test With the information we have shoe and inserts would be self-pay At this time we are unable to go further to help this patient Sincerely [redacted] / [redacted] Style Definitions */
The majority of our patients are referred to us from Orthopedist, Podiatrist, Rheumatologists, Wound Care Centers and other doctor that treat foot conditionsThat is why patients are given the diabetic packet that includes all of the required documents needed by Medicare to file a claimThe packet was given and explained to patient as noted in first letterMedicare requires that the doctor that treats a patient’s diabetes is the only physician that can complete the certifying statementIn addition that physician must perform a foot examination and dictate into the patients chart the findingsAgain this is a Medicare requirement, not an Upstate Pedorthic requirementThe first five calls to or from patient [redacted] , who along with her husband, the Pedorthist owns Upstate Pedorthic ServicesMrs [redacted] was concern that there was insufficient documentation for this claim to be approved by MedicareMrs [redacted] came to me and asked my opinion and I felt like, after working with new requirement from Medicare for the past year and a half it was unlikely they would cover for shoes and inserts with the documentation we haveAbout that same time Medicare offered a way to send in documentation (not claim) to determine if patient’s inserts and shoes would be coveredThe information we received about program stated we would receive reply by mail within daysWe were only given a fax number for communication for this programPer Medicare rules we cannot bill Medicare until patient has received their shoes and insertsMrs [redacted] explained to patient that if we filed a real claim and it was denied she would become responsible for paymentIt is our policy to protect our patients from unexpected cost by trying all the means at our disposal to assure claims would be coveredMrs [redacted] explained to patient in a phone conversation about program Exactly ten days after the documentation was faxed patient called office spoke to Mrs [redacted] and was very upset we had not received a replyMrs [redacted] explained this was a new program and asked [redacted] to call Medicare for status As I previously stated in last letter, Medicare said we had to wait on letter There was no way to contact that departmentPatient was very upset that we had said days and Mrs [redacted] explained we were giving her the information that Medicare had given to us about this programThis program is a Medicare program, the denial letter is on Medicare letterheadThe next day the patient contacted Medicare who then called me on a way callFirst Medicare said shoes and inserts are a covered services and I replied to Medicare rep that the information is correct, they are covered as long as the provider, in this case Upstate Pedorthic Services, has all the documentation requiredI went on to tell the Medicare rep where to find Medicare guidelines on Medicare’s website and she agreed That is when I explained what an ABN is, which is a form patient can sign if items are not covered by MedicareWe cannot give this form to diabetic patients to sign until we have confirmed or expect they do not meet Medicare guidelinesIt is Upstate Pedorthic Services desire to provided needed shoes and insets for our patients, but to also protect them from a significant cost We are very sorry that patient has been so dissatisfiedThankfully patient’s chart is well documented of all that took place and our office staff in trying to assets patient and her providerWe cannot make any provider sign forms or perform foot exams for Medicare requirementsWe have been in business for years and our goal has always been to give the best care to our patients This patient NEVER received any inserts or shoes from usIn addition we have spent countless man hours trying to help this patient get items above covered by MedicareWe also ordered shoes and had to return them, which cost us money for the shipping back and forth to the manufactureThis entire event is because the patient’s physician that treats her diabetes refused to do a foot examinationWe have dismissed this patient and will not provide any services / [redacted] Style Definitions */