This blog is adapted with permission from the author at drblakeshealingsole.com
Just as we know we can treat anything in the foot and ankle from ingrown toenails to plantar fasciitis to complex fractures, we know aging adults are prone to chronic foot problems, especially if they have an underlying disease such as diabetes. In a study of diabetic seniors (U.S. National Library of Medicine), it indicates that educating patients about foot self-care encourages routine foot care but that those dependent on either formal or informal support to perform foot care do so less frequently than those who perform it independently. We also know that Medicare doesn’t cover all podiatry services so acting independently to maintain overall foot health is crucial to avoid the need for podiatric Medicare.
Rules of Medicare
Medicare has specific rules for coverage, based on the patient’s diagnosis and proposed treatment. Make sure your physician understands these rules and helps to formulate a treatment plan around these guidelines. This will clarify why certain decisions are made. It also enlightens the patient as to how help can be provided not only for themselves but also for their loved ones now and in the future.
Medicare doesn’t cover routine foot care except in situations in which another health condition requires it and class findings (such as diabetic neuropathy) are met. It may be of benefit to incorporate this information into your initial patient exam. By understanding these class findings, you have a clear understanding as to why it may not be a covered service. If this is in fact the case, you can then follow up for an Advance Beneficiary Notice (ABN) for the non-covered service (MedicareSupplement.com). An ABN, also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service.
No Shoes For You
Medicare also doesn’t cover supportive devices, such as orthopedic shoes, unless they are included in the price of a leg brace or when the patient has diabetes. Even when the patient has diabetes, there is a specific algorithm that determines eligibility for this service and it may not include every patient with that diagnosis. Many patients with diabetes erroneously assume they are entitled to “free shoes” when in reality treatment is much more complicated than that. If “free” is not in the cards for you, an excellent alternative to diabetic shoes can be achieved through OTC insoles & inserts that are a fraction of the price while providing useful support needed for your foot.
Medicare will only cover podiatry services that are considered necessary to diagnose or treat a medical condition (Caring.com). Conditions such as hammertoes, heel spurs and bunion deformities yield Medicare coverage for treatment in the form of an evaluation and management visit. However, patients need to understand their evaluation and what to expect when it comes to coverage. Patients need to be made aware that Medicare Advantage plans specifically may require referrals or authorizations for certain services, such as X-rays.
Patients with diabetes may qualify more clearly for services when it comes to foot care because they have a greater risk of developing foot conditions (AARP). However, it is very important for them to understand the role of the podiatrist in their overall health and wellness. They should be seeing the doctor (primary physician or endocrinologist) treating their diabetes within six months of their podiatry visit. It is shocking that this is not routine for some patients with diabetes.
Helping Patients Understand How Medicare Pays For Podiatry Services
As podiatry services are mostly performed in an outpatient setting, Medicare Part B applies. Medicare Part B will pay 80 percent of covered medical costs. The patient is responsible for both an annual deductible and 20 percent of the bill. Many patients are not aware of the yearly deductible and are shocked when receiving their invoice. Optimally, physicians will take the time to educate patients, whether through postings in their office or even a brief conversation with all patients and staff.
If patients require surgery to treat a foot condition and are admitted to the hospital as inpatients, Medicare Part A will come in effect as well. A larger deductible applies here as does the 20 percent co-insurance. This deductible also covers the first 20 days in a skilled nursing facility (SNF) if it is recommended that the patient finish recovery there. Medicare will only cover the SNF stay if the patient was admitted to the hospital for at least three days (Podiatry Today).
When a patient applies for Medicare, he or she may ask what plans are recommended. Although this varies wildly by region, the patient may want to consider supplemental coverage to help pay for things traditional Medicare does not. Medicare plans such as Medigap and Medicare Advantage can help lower some of these costs. Medigap plans can help cover a patient’s Part A deductible and Part B deductible, copays, and coinsurance. Medicare Advantage plans can help lower a patient’s out-of-pocket costs by setting a copayment amount that may be lower than a patient’s normal Part B coinsurance. Medicare Advantage plans also may offer extra podiatry services, such as routine foot care exams. In certain situations, Medicare will also pay for orthotics -custom made as well as pre-fab OTC insoles (MedicareSupplement.com).
In summary, obtaining knowledge about Medicare and related insurance may help you maneuver through podiatry services as it relates to coverage. The confusing and complex aspects of insurance coverage may pose a barrier to obtaining the proper services needed and you want to limit that confusion by discussing with your physician if when available.