Manufacturer Fitter Certification Exam

1. True or False. The medical record must show that the certifying physician has had a face to face meeting with the patient to discuss the patients plan of care for diabetes in order to meet the medical necessity for diabetic footwear.

True

False

For service provided after January 1, 2011, the certifying MD or DO must meet personally with the patient no more than 6 months prior to shoes and inserts being dispensed, and the date of certification must not be more than 3 months after this meeting. The supplier is required to get the documentation from doctors office.

Explanation

For service provided after January 1, 2011, the certifying MD or DO must meet personally with the patient no more than 6 months prior to shoes and inserts being dispensed, and the date of certification must not be more than 3 months after this meeting. The supplier is required to get the documentation from doctors office.

2. How often should prescribed diabetic shoes and inserts be worn?

Only when indoors

No more than 2 hours per day

All the time, every day

Only when feet hurt

Diabetic footwear should be worn all the time, escpecially when outdoors.

Explanation

Diabetic footwear should be worn all the time, escpecially when outdoors.

3. True or false. When we measure a foot and it falls between sizes, we should pick the smaller size.

True

False

shoes which are too tight are not wearable, so its common sense to choose the larger size, when in doubt. Also many diabetics have edema, or swelling, which can add to the sizing. Be sure you account for swelling.

Explanation

shoes which are too tight are not wearable, so its common sense to choose the larger size, when in doubt. Also many diabetics have edema, or swelling, which can add to the sizing. Be sure you account for swelling.

4. Which is NOT True.

Diabetic footwear helps to cure peripheral neuropathy

Diabetic footwear can help reduce the chances of developing ulceration/amputation

Diabetic footwear helps reduce friction and pressures inside the shoe

Diabetic footwear is an important part of diabetic foot care

Diabetic footwear does not help to cure neuropathy.

Explanation

Diabetic footwear does not help to cure neuropathy.

5. Which is NOT a Correct statement.

All Diabetics qualify for diabetic shoes

Diabetic shoes help reduce the chances of ulcer development

Diabetic shoes should be worn with special inserts

Diabetic inserts have a HCPCS code

Not all diabetics qualify for diabetic shoes. Qualifications for diabetic shoes are:
1. Diagnosis of diabetes
2. presence of one additonal risk factor:
- Poor circulation in either foot
- History of ulcerations
- Foot deformity
- Neuropathy AND callus formation
- prior amputation

3. Patient must be under a plan of care for diabetes and MD must certify it.

Explanation

Not all diabetics qualify for diabetic shoes. Qualifications for diabetic shoes are:
1. Diagnosis of diabetes
2. presence of one additonal risk factor:
- Poor circulation in either foot
- History of ulcerations
- Foot deformity
- Neuropathy AND callus formation
- prior amputation

3. Patient must be under a plan of care for diabetes and MD must certify it.

6. True or False. Any good pair of shoes can be reimbursed by Medicare as diabetic shoes, if an MD or Podiatrist approves them.

True

False

Medicare approves shoes which are submitted by Manufacturers for approval. These have to have features which Medicare requires. Shoes without this "SADMERC Approval" cannot be provided or billed to Medicare. Doctors/Podiatrists cannot approve the items for Medicare.

Explanation

Medicare approves shoes which are submitted by Manufacturers for approval. These have to have features which Medicare requires. Shoes without this "SADMERC Approval" cannot be provided or billed to Medicare. Doctors/Podiatrists cannot approve the items for Medicare.

7. What percentage of the allowable cost, does Medicare pay for diabetic shoes and inserts?

50

75

80

100

After the patient's annual deductible is met, Medicare pays 80% of the allowable amount, and the patient pays a 20% co pay. This is true for all durable medical equipment under Part B.

Explanation

After the patient's annual deductible is met, Medicare pays 80% of the allowable amount, and the patient pays a 20% co pay. This is true for all durable medical equipment under Part B.

8. True or False. If a patient has had a partial amputation, such as the removal of the big toe, an insert with a toe filler should be supplied.

True

False

Toe fillers are custom inserts and can be provided by the lab. The fitter should send an impression box with the patient's impression. The billing code is HCPCS L5000 for inserts with toe fillers.

Explanation

Toe fillers are custom inserts and can be provided by the lab. The fitter should send an impression box with the patient's impression. The billing code is HCPCS L5000 for inserts with toe fillers.

9. True or False: if a patient has severe edema, the fitter should direct the patient to a style with a tighter upper, to help control and keep the swelling down.

True

False

The shoe should accommodate the patients condition. A stretchy, lycra type upper should be recommended to give and take with swelling. Tight shoes can create problems!

Explanation

The shoe should accommodate the patients condition. A stretchy, lycra type upper should be recommended to give and take with swelling. Tight shoes can create problems!

10. Which of the following would NOT be considered a foot deformity?

Hammer Toe

Bunion

Mallet Toe

Neuropathy

Neuropathy is the term for damage to nerves, not a condition of the feet.
A bunion is an abnormal, bony bump that forms on the joint at the base of your big toe. A hammertoe is a toe deformity in which your toe becomes curled up like a claw. mallet toe is a deformity similar to hammer toe. These conditions can cause constant rubbing inside your shoe.

Explanation

Neuropathy is the term for damage to nerves, not a condition of the feet.
A bunion is an abnormal, bony bump that forms on the joint at the base of your big toe. A hammertoe is a toe deformity in which your toe becomes curled up like a claw. mallet toe is a deformity similar to hammer toe. These conditions can cause constant rubbing inside your shoe.

11. True or False: A basic foot examination is required to be performed by the supplier in order to meet the documentation requirements to provide diabetic footwear

True

False

True. There must be documentation in the patient chart, of a basic foot examination, an in person fitting, and a statement by the fitter as to how the shoes and inserts will help the patient.

Explanation

True. There must be documentation in the patient chart, of a basic foot examination, an in person fitting, and a statement by the fitter as to how the shoes and inserts will help the patient.

12. Diabetic Footwear helps to prevent all of the following except _______.

Neuropathy

Ulceration

Amputation

Callus

Neuropathy is a condition of the nerves, not of the feet. The other items are related to the feet which can be helped or prevented, by wearing diabetic footwear.

Explanation

Neuropathy is a condition of the nerves, not of the feet. The other items are related to the feet which can be helped or prevented, by wearing diabetic footwear.

13. true or false. If the patient requests it, and they live more than 10 miles from the supplier's place of business, and if the prescription and certification is on file, it is permissable to ship the shoes and inserts to the patient's home.

True

False

It is never permissable. An in-person final fitting, and delivery, must be completed, and signed for, by the patient. The patient must be given instructions on proper use and care of the product, and the final fitting must be made and accepted by the patient- in person.

Explanation

It is never permissable. An in-person final fitting, and delivery, must be completed, and signed for, by the patient. The patient must be given instructions on proper use and care of the product, and the final fitting must be made and accepted by the patient- in person.

14. Using the Ritz Stick, a woman measures size 9 on the left foot and size 9.5 on the right foot. Which size should we order for her.

9

9.5

10

One size 9 and one size 10

up to one size can be accommodated with spacers, Order size 9.5 for the larger foot, and add a spacer if needed on the smaller foot. You can "split pairs" (two sizes) for an additional charge, but in practice this is usually done only if the size difference is more than a full size.

Explanation

up to one size can be accommodated with spacers, Order size 9.5 for the larger foot, and add a spacer if needed on the smaller foot. You can "split pairs" (two sizes) for an additional charge, but in practice this is usually done only if the size difference is more than a full size.

15. True or False. A supplier is required to heat up the diabetic inserts, in order to bill Medicare for HCPCS A5512.

True

False

To bill for diabetic inserts under HCPCS A5512, the inserts must be heated to a temperature of 230 degrees, and molded directly to the patients feet, to achieve total arch contact.

Explanation

To bill for diabetic inserts under HCPCS A5512, the inserts must be heated to a temperature of 230 degrees, and molded directly to the patients feet, to achieve total arch contact.

16. Which of the following is NOT a benefit of diabetic shoes?

Snugger fit

Higher toe box

Extra depth

Lightweight

Diabetic shoes should not be tight on the foot. Diabetic shoes should provide penty of room and not create points of friction.

Explanation

Diabetic shoes should not be tight on the foot. Diabetic shoes should provide penty of room and not create points of friction.

17. How many diabetic inserts (insoles) will Medicare allow each year, for a qualified patient?

1

2

4

6

Billing is done by unit, not by pair. So, Medicare allows up to 6 UNITS of inserts (insoles) for diabetic shoes, each calendar year. If you were looking for "3", you're thinking "pairs"..but that is not how the items are billed or reimbursed.

Explanation

Billing is done by unit, not by pair. So, Medicare allows up to 6 UNITS of inserts (insoles) for diabetic shoes, each calendar year. If you were looking for "3", you're thinking "pairs"..but that is not how the items are billed or reimbursed.

18. Diabetic shoes are reimburseable under the benefits of Medicare Part _____

Part A

Part B

Part C

Part D

Diabetic shoes are a part B benefit, classified as Durable Medical Equipment.

Explanation

Diabetic shoes are a part B benefit, classified as Durable Medical Equipment.

19. true or false: Inserts are changed by the patient every 6 months.

True

False

False. Inserts should be changed as needed but not more than 120 days (4 months). A patient is issued 3 sets for the year.

Explanation

False. Inserts should be changed as needed but not more than 120 days (4 months). A patient is issued 3 sets for the year.

20. The HCPCS code for "off the shelf, extra depth shoes, made for diabetics" is ______

A5512

A5513

A5510

A5500

HCPCS A5512 is for heat moldable inserts, A5513 is for custom fabricated inserts, A5510 is for custom shoes (not off the shelf) so A5500 is the proper code.

Explanation

HCPCS A5512 is for heat moldable inserts, A5513 is for custom fabricated inserts, A5510 is for custom shoes (not off the shelf) so A5500 is the proper code.

21. True or False. All diabetic inserts are reimbursed the same by Medicare.

True

False

Diabetic inserts are reimbursed differently based on the construction and HCPCS code. There are 3 basic codes.
A5512 is for heat moldable diabetic inserts. A5513 is for inserts custom made for a patients foot using a model of the patients foot to create it. L5000 is for a custom insert which has accommodations for missing toes, or other accommodations. Each of these reimburses a different amount.

Explanation

Diabetic inserts are reimbursed differently based on the construction and HCPCS code. There are 3 basic codes.
A5512 is for heat moldable diabetic inserts. A5513 is for inserts custom made for a patients foot using a model of the patients foot to create it. L5000 is for a custom insert which has accommodations for missing toes, or other accommodations. Each of these reimburses a different amount.

22. True or False. Medicare requires a Podiatrist to certify the medical need for diabetic footwear.

True

False

A podiatrist can prescribe the shoes, but the medical need must be certified by the MD or DO, who is treating the patients diabetes. A Podiatrist cannot certify the medical need.

Explanation

A podiatrist can prescribe the shoes, but the medical need must be certified by the MD or DO, who is treating the patients diabetes. A Podiatrist cannot certify the medical need.

23. Which is not true about custom inserts (A5513)

They cost more

They reimburse more

They achieve and maintain total arch contact

They are heat molded to the patient's foot by the fitter

custom inserts are fabricated from a mold or scan of the patient's foot by a certified orthotic lab. They acheive and maintain arch contact, cost more, and are reimbursed at a higher rate than heat moldable inserts (A5512).

Explanation

custom inserts are fabricated from a mold or scan of the patient's foot by a certified orthotic lab. They acheive and maintain arch contact, cost more, and are reimbursed at a higher rate than heat moldable inserts (A5512).

24. How many diabetic shoes will Medicare allow each year, for a qualified patient?

6

2

3

1

gotcha? Medicare allows 2 UNITS, per calendar year. Billing is done by UNIT, not by pair, as in, 1 left shoe, and 1 right shoe. Why, you ask? Simple. Some diabetic patients don't have two feet. If one has been amputated, you cant bill for a diabetic shoe for a right foot.. which isn't there. So, yes this was a trick question. How'd you do?

Explanation

gotcha? Medicare allows 2 UNITS, per calendar year. Billing is done by UNIT, not by pair, as in, 1 left shoe, and 1 right shoe. Why, you ask? Simple. Some diabetic patients don't have two feet. If one has been amputated, you cant bill for a diabetic shoe for a right foot.. which isn't there. So, yes this was a trick question. How'd you do?

25. Using the Ritz Stick, a man measures as size 11 in length, and 23 in width. Using the conversion chart on the back of the Ritz Stick, what would the correct shoe width be?

D

E

EE

EEE

see Ritz Stick

Explanation

see Ritz Stick