Qualifying Medicare Patients for Therapeutic Shoes

For someone diagnosed with diabetes mellitus, Medicare may cover the cost of therapeutic shoes and custom inserts; however, specific criteria must be met in a face-to-face exam. First, only a Medical Doctor (MD) or a Doctor of Osteopathy (DO) can order diabetic-friendly footwear and inserts. If the face-to-face is completed by a Podiatrist, Physician’s Assistant (PA-C) or Nurse Practitioner (APRN/NP), then there must be a physician who agrees with the foot exam and plan for shoes/inserts. 

The physician must certify that the patient has diabetes and is under a comprehensive plan of care for his/her diabetes. It must also document that the patient suffers from one or more of the following conditions (the more specific the better): 

  • Amputation of the foot or part of the foot
  • History of previous foot ulceration of either foot
  • History of pre-ulcerative calluses of either foot
  • Peripheral neuropathy with evidence of callus formation of either foot
  • Foot deformity of either foot
  • Poor circulation of either foot

Medicare will cover the cost of the therapeutic shoes and inserts if all of the criteria is met. They will cover one new pair of therapeutic shoes per calendar year, along with three pairs of custom inserts


A5500 Therapeutic Shoes

A5514 Insert (Camera-Tech Molded)

A5513 Insert (Foot-Contact Molded)

A5512 Insert (Heat Moldable)

Written by:

Joselin Lockard, RRT

Frontier Home Medical Sales Representative

(Kearney, Grand Island, Lincoln)


Patients have many questions and concerns when choosing a home care company to provide them with oxygen. 


At Frontier Home Medical, we know that each oxygen device has its own benefits and features. Understanding the patient’s prescription, lifestyle and usage needs will help us determine just the right oxygen device. We call it the Best Match Protocol.


We offer a 24/7 After Hours Emergency Line. In addition, trained on-call staff is available for oxygen setups.


At Frontier, patients receive a consultation with trained Patient Care Technicians during equipment set up and are given simple, easy-to-understand educational 
materials to read and refer to. We also have on-staff Respiratory Therapists to answer any questions your patients may have. 


Yes, the billing experts at Frontier Home Medical work closely with providers and insurance companies. This is such an essential piece of the process, to know upfront what is needed to qualify a patient for equipment and also communicate what, if any, financial responsibility may be. 


Continuous flow gives a steady stream of oxygen; pulse flow is based on breath rates. For patients who do not require a heavier concentration of oxygen, the convenience of pulse flow oxygen may be something to consider for your patient’s needs.


Traveling with oxygen by car or other means of transportation may seem intimidating. However, with a little planning, it can be easily, and safely, done. At Frontier, we can offer patients several options that make traveling easier, such as Portable Oxygen Concentrators and small tanks with conserving devices. It’s always a good idea for your patients to have a letter and copy of their prescription with them during travel. 


Patients truly are in good hands at Frontier Home Medical. We have the equipment and clinical expertise to find the right product for each person’s needs. Patients have access to on-staff Respiratory Therapists. They get consultation with trained Patient Care Technicians during set up. We are experts in insurance coverage. When it comes to oxygen therapy, we have it covered!

Written by: Anne Seaman – Frontier Home Medical Sales Representative (Cozad, McCook, North Platte)

Pressure Ulcers Guidelines

Risk assessment and prevention of pressure ulcers:
a clinical practice guideline from the American College of Physicians

Authors: Amir Qaseem, Tanveer P Mir, Melissa Starkey, Thomas D Denberg

Publisher: Clinical Guidelines Committee of the American College of Physicians

Abstract: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations based on the comparative effectiveness of risk assessment scales and preventive interventions for pressure ulcers.

Methods: This guideline is based on published literature on this topic that was identified by using MEDLINE (1946 through February 2014), CINAHL (1998 through February 2014), the Cochrane Library, clinical trials registries, and reference lists. Searches were limited to English-language publications. The outcomes evaluated for this guideline include pressure ulcer incidence and severity, resource use, diagnostic accuracy, measures of risk, and harms. This guideline grades the quality of evidence and strength of recommendations by using ACP’s clinical practice guidelines grading system. The target audience for this guideline includes all clinicians, and the target patient population is patients at risk for pressure ulcers.

Full text: https://pubmed.ncbi.nlm.nih.gov/25732278/

Categorizing Incontinence

Incontinence: It takes a Team; Categorizing Incontinence

Publication: Provider Magazine

Author: Amy Mendoza

Publisher: American Health Care Association/National Center for Assisted Living

“Vetter Health Services, headquartered in Elkhorn, Neb., takes a restorative approach to bowel and bladder retraining. When new residents walk in the door, staff assess them for incontinence and take it a step further to determine the type of incontinence they have.

‘This can fall into one of four categories—stress, urge, transient, and functional,’ says Michelle Wallace, RN-BC, a certified registered rehabilitation nurse and clinical coordinator at Vetter. One of four clinical coordinators for Vetter, she has overseen operations regionally for the past six years and has a self-described passion for restorative care.”

Stress: Incontinence related to the weakening of the muscle structure. Sneezing, coughing, standing up, any kind of movement can cause a leakage.

Urge: Incontinence brought on by irritation of the urinary system. Stimulants come into play, and serious urgency is related to it. When a resident needs to go, they need to go immediately. 

Transient: Incontinence of a reversable type. The resident may have a urinary tract infection, or they are on a type of medication, something that is typically reversible. Once the particular issue is addressed, continence is restored.

Functional: Incontinence related to a functional limitation either with the resident’s ability to move or things in their environment that functionally inhibit them from being continent.

Mixed: Incontinence that could be a combination of any of the four types.”

Full text: https://www.providermagazine.com/Monthly-Issue/2019/November/Pages/Incontinence-It-takes-a-Team.aspx

“Incontinence: It takes a Team”; Provider Magazine, COPYRIGHT 2019.


Home Non-Invasive Ventilation Use Following Acute Hypercapnic Respiratory Failure in Chronic Obstructive Pulmonary Disease

Publication: Respiratory Medicine

Study Authors: Matos, P; Kampelmacher, MJ; Esquinas, AM

Publisher: Science Direct

In 2011, 166 COPD patients were studied to evaluate the effectiveness of Non-Invasive Positive Pressure Ventilation (NPPV). Half of the patients utilized the at-home therapy; the other half did not. Over the course of 6 months, these were the findings.

“Results: Patients in the NPPV post discharge group demonstrated superior event-free survival compared to the no-NPPV post discharge group (х2 = 23.8, p < 0.0001). The NPPV post discharge group had a statistically significant reduction in hospital readmissions (40% versus 75%, p < 0.0001) through 180 days from the index admission.

Conclusions: Patients who used NPPV following an admission for AECOPD with hypercapnic respiratory failure had lower readmission rates and improved event-free survival after 180 days from an index admission compared to patients who did not use NPPV post discharge.”

Full text: https://www.sciencedirect.com/science/article/pii/S0954611114001140

“Home non-invasive ventilation use following acute hypercapnic respiratory failure in COPD”; Respiratory Medicine, COPYRIGHT 2011.


Non-Invasive Ventilation (NIV) and Hypercapnia-Associated Symptoms in Amyotrophic Lateral Sclerosis (ALS)

Publication: Acta Neurologica Scandinavica

Study Authors: Dorst, J; Behrendt, G; Ludolph, AC.

Publisher: Wiley-Blackwell; Country of Publication: Denmark

Objectives: During the course of amyotrophic lateral sclerosis (ALS), progressive weakness of respiratory muscles leads to chronic hypercapnia which causes various symptoms like sleep disturbances, daytime fatigue, and depression. Non‐invasive ventilation (NIV) improves survival and quality of life, but little is known about its effect on these specific symptoms, in particular during the later course of disease. Our aim was to evaluate the short‐ and long‐term effects of NIV on hypercapnia‐associated symptoms in ALS.

Material and Methods: We prospectively analyzed sleep disturbance, daytime fatigue, and depression using standardized scales (Pittsburgh sleep quality index [PSQI], Stanford sleepiness scale [SSS], Beck depression inventory [BDI], and Clinical hypoventilation score [CHS]) in 58 patients with NIV. Follow‐up was done every 3 months up to a maximum of 24 months.

Hypercapnia‐Associated Symptoms: Baseline values of PSQI, SSS, BDI, CHS, and ALSFRS‐R are shown in Figure 2. The majority of patients (70.3%) showed pathological results in the PSQI. The BDI revealed mild depression in n = 9 patients (15.6%), a moderate depression in n = 6 patients (10.3%), and a severe depression in n = 2 patients (3.4%). Median BDI was higher in patients with bulbar onset (11.5; 95% CI: 9.0‐18.0) than in patients with spinal onset (7.0; 95% CI: 4.0‐8.5; P = 0.011), indicating a higher incidence of depression in bulbar patients. For SSS and CHS, there are no pathological threshold values. The CHS, which comprises all known hypercapnia‐associated symptoms, was significantly higher in patients with pCO >45 mm Hg (24.0; 95% CI: 16.0‐32.0) than in patients with pCO ≤45 mm Hg (11.0; 95% CI: 9.0‐18.0).

Graph: Baseline values of scores for hypercapnia‐associated symptoms and ALSFRS‐R Colored lines mark pathological thresholds (PSQI) and thresholds for mild, moderate, and severe depression (BDI). ALSFRS‐R, amyotrophic lateral sclerosis functional rating scale; BDI, beck depression inventory; CHS, clinical hypoventilation score; PSQI, Pittsburgh sleep quality index; SSS: stanford sleepiness scale

Results: We found significant improvements of all outcome parameters except BDI within the first three months after NIV initiation. The median PSQI improved from 6.5 (95% CI: 5.0‐8.5) to 6.0 (95% CI: 4.5‐7.0; P = 0.042), the SSS from 3.0 (95% CI: 2.0‐4.0) to 2.0 (95% CI: 2.0‐3.0; P = 0.004), and the CHS from 22.0 (95% CI: 19.5‐25.0) to 18.0 points (95% CI: 12.0‐23.5; P = 0.013). Patients with bulbar and spinal onset were not significantly different, and positive effects were long‐lasting.

Conclusions: Our data show that NIV improves hypercapnia‐associated symptoms within the first 3 months after initiation in spinal as well as bulbar patients, and that beneficial effects are long‐lasting.

In summary, our data indicate that, NIV improves blood gases, quality of sleep, and daytime fatigue, confirming previous studies, beneficial effects are long‐lasting and may be preserved by adjusting ventilation times and parameters, the effects are present in patients with bulbar involvement as well, and other hypercapnia related symptoms such as morning headache, vegetative symptoms, and cognitive decline might improve as well, although further studies are needed for confirmation.”

Full text: https://onlinelibrary.wiley.com/doi/abs/10.1111/ane.13043

“Non-invasive ventilation and hypercapnia-associated symptoms in amyotrophic lateral sclerosis.” Acta neurologica Scandinavica, COPYRIGHT FEBRUARY 2019.

The Necessity of Seat Elevation for Power Wheelchairs

RESNA Position on the Application of Seat Elevation Devices for Power Wheelchair Users

Authors: Schiappa, MS ATP; Piriano, PT ATP/SMS; Bernhardt, PT MPT ATP; Shea, MA OTR ATP; Maurer, PT MPT ATP; Rosen, PT MPT MSMS ATP/SMS; Lange, OTR/L ABDA ATP/SMS; Schmeler, PhD OTR/L ATP; Dicanno, MD

Publisher: Rehabilitation Engineering and Assistive Technology Society of North America

What is a seat elevation device for a wheelchair? 

“A power seat elevation device is a seat function component of a wheelchair that raises and lowers users while remaining in a seated position through the use of an electromechanical lift system to provide varying amounts of vertical seat to floor height. It does not change the seated angles or the seat’s angle relative to the ground. A seat elevation device may elevate vertically from a standard seat height or may lower the user closer to the floor.”

Why is seat elevation so important to its user?

“Wheelchair mobility is often only considered from the perspective of people moving from one point to another on a two-dimensional plane. Vertical movement is necessary for people to function and participate in a three- dimensional world. A common intervention that provides vertical mobility within a wheelchair is a seat elevation device.”

Full text: https://www.resna.org/Portals/0/Documents/Position%20Papers/RESNA_App%20of%20Seat%20Elevation%20Devices%202019.pdf

Summary: “Power seat elevation devices allow an individual who uses a power wheelchair to independently change their seat to floor height. Increasing seat height can increase functional reach (vertical and horizontal reaching ability) as well as decrease the amount of overhead reaching that is required. Overhead reach can lead to injury and pain of the shoulder, neck and upper extremities. Changing the seat height in relation to other surfaces can increase transfer safety and efficiency as well as reduce injuries and fall risk. Seat elevation devices can also improve line of sight with others and with the environment. Without a more direct line of sight, individuals in wheelchair tend to assume cervical extension which can lead to fatigue, pain and even elicitation of a symmetrical tonic neck reflex (STNR). Power seat elevation devices are an important power wheelchair seat function which can improve overall function; safety; efficiency; and reduce fatigue; injury; and pain to minimize the risk for adverse medical outcomes and resulting healthcare costs.”

“RESNA Position on the Application of Seat Elevation Devices for Power Wheelchair Users” Approved by RESNA Board of Directors in 2019.

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