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Paul Kesselman
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About me
Dr, Kesselman was in private practice in NYC for over 35 years and is board certified by the American Board of Foot and Ankle Surgery. He has over twenty
five years of consulting experience in many areas of health policy providing expertise on Medicare and third party payment regulations.
He is a member of all four DME MAC Medicare Councils and has a regular column in Podiatry Management.
five years of consulting experience in many areas of health policy providing expertise on Medicare and third party payment regulations.
He is a member of all four DME MAC Medicare Councils and has a regular column in Podiatry Management.
Posts made by Paul Kesselman
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hwlloposted in Community Guidelines
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Surety Bond Follow upposted in Compliance and reimbursement pearls
A recent posting outlining what happened to a pedorthic provider has some readers a bit on edge, so I would like to calm those nerves by providing some further clarifications. Surety Bondi...
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Surety bond as example of what not to doposted in Compliance and reimbursement pearls
A recent encounter with a provider of DMEPOS (not a podiatrist, but a pedorthist) should be a warning shot across the bow to every provider and certainly to every compliance and enrollment ...
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L1951 3rd postingposted in Compliance and reimbursement pearls
The past two forum postings have reviewed the DMEPOS prior authorization process and the clinical requirements for L1951. This last forum posting on this subject will discuss more on the specific r...
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L1951 2nd forum postingposted in Compliance and reimbursement pearls
The last forum discussed the DMEPOS prior authorization program as one way of CMS stemming the flow of money to the provider and is done prior to services or DME being provided. This edition of th...
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Prior Authorization Programposted in Compliance and reimbursement pearls
Medicare, in its attempt to stem payments to providers and reduce fraud and abuse, CMS has now expanded its DMEPOS Prior Authorization program to include HCPCS L1951, a very specific type of AFO di...
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Proper Documentation for Custom Foot Orthotics 9posted in Compliance and reimbursement pearls
Many clients have asked beyond the HCPCS codes for custom fabricated foot orthotics and casting code, what other HCPCS or CPT codes are available for reimbursement? Gait analysis...
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Proper Documentation for Custom Foot Orthotics 8posted in Compliance and reimbursement pearls
Many clients have asked how to bill Medicare for custom foot orthotics when the patient’s secondary insurance does, but must first be rejected by Medicare? This scenario is...
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Proper Documentation for Custom Foot Orthotics 7posted in Compliance and reimbursement pearls
The last 6 installments of this column have provided some insights into proper documentation and coding of the foot orthotic device itself. This installment will discuss the proper completio...
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Proper Documentation for Custom Foot Orthotics 6posted in Compliance and reimbursement pearls
The last four installments in this forum dealt with the three steps of required documentation for reimbursement for custom foot orthotics and L3000. To summarize those steps were proper cli...
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Proper Documentation for Custom Foot Orthotics 5posted in Compliance and reimbursement pearls
The last four installments in this forum dealt with the three steps of required documentation for reimbursement for custom foot orthotics and L3000. To summarize those steps were proper clinical do...
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Proper Documentation for Custom Foot Orthotics 4posted in Compliance and reimbursement pearls
The last three installments in this forum dealt with the first three steps of required documentation for reimbursement for custom foot orthotics. To summarize those steps were proper clinic...
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Proper Documentation for Custom Foot Orthotics 3posted in Compliance and reimbursement pearls
The last two installments in this forum dealt with the first two steps of required documentation for reimbursement for custom foot orthotics. To summarize those steps were proper clinical documenta...
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Proper Documentation for Custom Foot Orthotics 2posted in Compliance and reimbursement pearls
Assuming all the clinical requirements for the medical necessity for custom foot orthotics have been met, what other issues must the chart documentation address? There are two major issues which m...
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Proper documentation for custom foot orthotics 1posted in Compliance and reimbursement pearls
What must I document in my patient’s chart to document medical necessity for custom foot orthotics? This is a common question asked by many of my clients. There are many issues to address wit...
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SWO Do I need oneposted in Compliance and reimbursement pearls
Several colleagues have recently been hit with audit denials for an incomplete or absent Standard Written Order (SWO). Why can’t Medicare get this right? A Standard Written Order in DME parl...
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Virtual Prescribingposted in Compliance and reimbursement pearls
A great question was recently raised as to whether a physician can prescribe an AFO (or any device) to a patient they are not physically examining? That is can telemedicine substitute for the in p...
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L5000 coverageposted in Compliance and reimbursement pearls
If a patient is not a diabetic and has a partial foot amputation does Medicare cover a partial foot filler (L5000) The short answer is that whether the patient is diabetic or not, the L5000 would ...
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Football and DMEposted in Compliance and reimbursement pearls
Often clinicians groan about third party payers and their devious schemes to deny their claims. Are carriers out to get you or are they simply asking you to play by their rules? Let’s make a...
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What does the KX modifier signify and when should I use it?posted in Compliance and reimbursement pearls
The KX modifier is a payment modifier used almost exclusively with HCPCS codes. It signifies to the payer, whether Medicare or not, that the claim for whatever DMEPOS you are billing, has corrobora...
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