Documentation Required

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Certification Statement​​​​​​ - The practitioner must obtain a signed statement from the certifying physician specifying:

 

  1. That the patient has diabetes mellitus
  2. Has one of the conditions 2a-2f listed in the policy who qualifies
  3. Is being treated under a comprehensive plan of care for his/her diabetes
  4. Needs diabetic shoes


The certifying physician must be either an M.D. or D.O. and may not be a podiatrist.

Recommendations for Certifying the Patient for Shoes and Inserts are provided in the User Manual, Certification Section

Cover Letter for submittal of Statement of Certifying Phyisican Form
Statement of Certifying Physician Form

Prescription - The practitioner delivering shoes, inserts or modification must keep a signed (by the prescribing physician) and dated order in the patient’s file. If the prescribing physician is the practitioner delivering the shoes (such as a podiatrist), a separate order is not required.

Recommendations for Certifying the Patient for Shoes and Inserts are provided in the User Manual, Prescription Section.

Office Records - All services reimbursed by Medicare are subject to audit performed by the agency at its discretion. The documentation must demonstrate both medical necessity and the level of service provided.

Recommendations and samples for proper documentation and record keeping are provided in the User Manual, Charting Section.

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