INSTRUCTIONS TO QUALIFY FOR THERAPEUTIC FOOTWEAR THROUGH MEDICARE
We are looking forward to helping you protect your feet from breakdown and/or ulceration by using properly fitted diabetic footwear. Please follow these instructions to help us speed up getting you into your new shoes. 1. Take the enclosed Diabetic Footwear Prescription Form to either your M.D., D.O., Endocrinologist or Podiatrist to complete. The prescription must be specific as to the type of footwear and inserts you require. Please remember this prescription is only valid for 90 days from the date it is signed. You must receive your new items within 90 days of the prescription date, so please don’t delay in calling us for a fitting appointment. 2. Take the enclosed Statement of Certifying Physician to your Medical Doctor who is treating you for diabetes and have them complete this form. This form cannot be signed by anyone except an M.D. or D.O. 3. PLEASE NOTE THAT YOUR DOCTOR MUST ALSO SEND US CLINICAL CHART NOTES FROM YOUR VISIT, AND THEY MUST INCLUDE KEY INFORMATION REQUIRED BY MEDICARE. This is explained further in the Guidelines for Clinical Notes (Page 4). We must emphasize Medicare requires this additional information and without it, Medicare will deny our claim for your shoes and inserts, thereby making you responsible for the charges. Your Primary Care Doctor or Endocrinologist may not be comfortable with documenting your foot condition(s) and may require you to first obtain this detailed information from your Podiatrist. If provided by a non-M.D. or D.O., your PCP/Endocrinologist must sign, date and indicate agreement with their findings. 4. Once all of your paperwork is complete, contact one of our 12 clinics for a fitting appointment. Our Practitioner will assist you with the selection of footwear and diabetic inserts prescribed by your doctor.