Breaking News Regarding the Therapeutic Shoe Program!
On November 5th, 2020, the DME MACs released two joint publications detailing expansion of the roles of Nurse Practitioners (NP) and Physician Assistants (PA) in certifying therapeutic shoes and inserts for beneficiaries. CMS is utilizing its authority under the soon-to-be-launched Primary Care First (PCF) model to waive Social Security Act 1861(s)(12), the section which requires that an MD or DO only, is permitted to certify therapeutic shoes and inserts for beneficiaries.
The articles summarize the expanded role of NPs who are participating in the Centers for Medicare and Medicaid’s PCF Model Demonstration project in 26 designated regions in the USA and the expanded role of NPs and PA’s who are practicing “incident to” a supervising physician’s authority. In the 26 selected regions, NPs who are participating in the PCF demonstration are eligible to serve as Certifying Physicians for therapeutic shoes and inserts effective Jan 1st, 2021 through December 31, 2125. Other NPs and PA’s are also eligible if practicing “incident to” a supervising physician and all the following criteria are met:
1. The supervising physician has documented in the medical record that the patient is diabetic and has been, and continues to provide the patient follow-up under a comprehensive management program of that condition, and,
2. The NP or PA certifies that the provision of the therapeutic shoes is part of the comprehensive treatment plan being provided to the patient; and,
3. The supervising physician must review and verify (sign and date) all of the NP or PA notes in the medical record pertaining to the provision of the therapeutic shoes and inserts, acknowledging their agreement with the actions of the NP or PA
NPs who are practicing independently and bill under their own NPI in certain states may be eligible if enrolled in the PCF Model.
Although additional information is forthcoming, podiatry practices should ensure compliance of course.
For criteria #1, while it is not required to have specific wording that the supervising physician has already documented the diabetes in the past and continues to provide follow up, it’s not a bad idea to confirm that the patient has been examined by the supervising MD or DO at least once.
For criteria #3, supervising physicians who are now permitted to co-sign in-person or telehealth exams performed by NP or PA’s in their own practices, must use wording that they “agree” or “concur” with the exam and actions of the provider, then sign and date.
Claims for NPs and PA’s who are practicing “incident to” in primary practices are submitted as if the physician personally performed the service. The NPs and PA’s are not listed on their claims.
This is great move by CMS, and great news for podiatrists and their diabetic patients who need therapeutic shoes and inserts, especially those who are being treated by NPs or PAs in primary care practices. The PCF demonstration model was initiated to place more emphasis on improving beneficiary care by reducing administrative burdens and providing greater flexibility to primary practices. For diabetics, the lifetime risk to develop a foot ulcer is 34%, with more than 50% of those ulcers becoming infected. Eliminating obstacles that may delay or prevent diabetic patients from receiving their diabetic shoes and inserts each year, is a big step in the right direction.
Below are the links to the two policy articles:
Medicare Compliance Officer Dia-Foot