1.
Which is NOT a Correct statement.
Correct Answer
A. All Diabetics qualify for diabetic shoes
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.
2.
How many diabetic shoes will Medicare allow each year, for a qualified patient?
Correct Answer
B. 2
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?
3.
How many diabetic inserts (insoles) will Medicare allow each year, for a qualified patient?
Correct Answer
D. 6
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.
4.
How often should prescribed diabetic shoes and inserts be worn?
Correct Answer
C. All the time, every day
Explanation
Diabetic footwear should be worn all the time, escpecially when outdoors.
5.
Diabetic shoes are reimburseable under the benefits of Medicare Part _____
Correct Answer
B. Part B
Explanation
Diabetic shoes are a part B benefit, classified as Durable Medical Equipment.
6.
The HCPCS code for "off the shelf, extra depth shoes, made for diabetics" is ______
Correct Answer
D. A5500
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.
7.
True or False. A supplier is required to heat up the diabetic inserts, in order to bill Medicare for HCPCS A5512.
Correct Answer
A. True
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.
8.
True or False. Any good pair of shoes can be reimbursed by Medicare as diabetic shoes, if an MD or Podiatrist approves them.
Correct Answer
B. False
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.
9.
True or False. Medicare requires a Podiatrist to certify the medical need for diabetic footwear.
Correct Answer
B. False
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.
10.
Which of the following is NOT a benefit of diabetic shoes?
Correct Answer
A. Snugger fit
Explanation
Diabetic shoes should not be tight on the foot. Diabetic shoes should provide penty of room and not create points of friction.
11.
What percentage of the allowable cost, does Medicare pay for diabetic shoes and inserts?
Correct Answer
C. 80
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.
12.
Which of the following would NOT be considered a foot deformity?
Correct Answer
D. Neuropathy
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.
13.
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.
Correct Answer
A. True
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.
14.
Which is not true about custom inserts (A5513)
Correct Answer
D. They are heat molded to the patient's foot by the fitter
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).
15.
True or false. When we measure a foot and it falls between sizes, we should pick the smaller size.
Correct Answer
B. False
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.
16.
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
Correct Answer
A. True
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.
17.
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.
Correct Answer
B. False
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.
18.
True or false: Inserts are changed by the patient every 6 months.
Correct Answer
B. False
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.
19.
Which is NOT True.
Correct Answer
A. Diabetic footwear helps to cure peripHeral neuropathy
Explanation
Diabetic footwear does not help to cure neuropathy.
20.
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.
Correct Answer
A. True
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.
21.
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.
Correct Answer
B. False
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!
22.
Diabetic Footwear helps to prevent all of the following except _______.
Correct Answer
A. Neuropathy
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.
23.
True or False. All diabetic inserts are reimbursed the same by Medicare.
Correct Answer
B. False
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.
24.
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.
Correct Answer
B. 9.5
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.
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?
Correct Answer
B. E
Explanation
see Ritz Stick