The Podiatric Practice Manual A Guide to Running an Effective Practice Joseph S. Borreggine, DPM, FACFAS Table of Contents SECTION I CLINICAL CARE 1 A. Treatment Algorithms 2 Diabetic Foot Care Algorithm 3 Plantar Fasciitis Algorithm 4 Onychomycosis Treatment Algorithm 6 Local Anesthetic Injections Protocol 7 Phenol and Alcohol Ingrown Nail Correction Procedure 10 Fiberglass Impregnated Sock Application for Custom Molded Shoes and Rx Braces 12 Ancillary Podiatric Services Algorithm 13 Preparing Patients for Surgery 14 B. X-ray Positioning 14 Anterior Posterior (AP) View (or Dorsoplantar View) 15 Lateral Projection, Weight Bearing (Medial View) 15 Lateral Oblique Projection (Medial Oblique View) 16 Medial Oblique Projection (Lateral Oblique View) 16 Lateral Projection of the Ankle (Medial Oblique View) 16 Axial Sesamoid View 17 Anterior Posterior View of the Ankle 18 Mortise View of the Ankle 18 Axial Calcaneal View of the Heel 19 Harris-Beath View of the Heel 20 C. General Clinical Care Policies and Procedures 20 Patient Being Left Alone 20 Redressing Surgical Wounds 20 In-Office Emergency 21 Hand Sanitation 21 Exposure Control Plan 22 D. Documentation 22 Patient Medical Record 22 Documentation Basics 23 Documentation Format 23 Documentation of Lab Work 23 Documentation of Prescriptions 24 Documentation of Complimentary Foot Exams
24 Using Dictation 25 Privacy Issues/HIPAA Compliance 25 HIPAA Violations 26 Medical Record Storage 27 E. Medical Instruments, Equipment and Supplies 27 Medical Instruments 27 Sterilization Procedures 27 Cold Sterilization Procedures 28 Steam Sterilization (Autoclave) Procedures 29 Sterile Instrument Handling and Storage 29 Medical Equipment 29 Nail Grinder Care 30 Durable Medical Equipment (DME) Procedures 30 Diabetic Therapeutic Shoes and Insoles 30 Prescription Diabetic Therapeutic Shoes/Insoles 31 Non-prescription Diabetic Shoes and Insoles 32 Placing Orders for DME 32 Receiving DME 33 Scheduling Patients for DME Pickup 33 Dispensing DME 35 DME Billing 35 DME Returns 35 Supplies 35 Ordering Supplies 36 Pharmaceutical Samples 37 F. Clinical Care Forms 37 Updates 37 Established Patient Medical Record Update 39 New Patient Consultation 42 Foot Screen Evaluation Form 44 Six Month Foot Care Update for Patients with Diabetes 46 Questionnaire for Patients with Diabetes 48 Consent for Treatment Patient with Peripheral Vascular Disease or Diabetes 50 Surgery Forms 50 Pre-operative Patient Questionnaire 51 Pre-surgery Form 52 Consent for Podiatric Surgical Procedure 55 Post-operative Management 56 Post-operative Instruction Sheet 58 Post-operative Instructions 60 In-patient Surgery 61 Outpatient Surgery 63 Outpatient Surgical Instructions
66 Patient Acknowledgement of Outpatient Foot Surgery Forms 67 DME Forms 67 Diabetic Shoe Order Form 68 Diabetic Shoe Prescription Form 69 Patient Authorization for Payment/Warranty Statement for Shoe/Inserts 71 Patient Authorization for Payment and Warranty Statement for Braces 72 Orthotic Insurance Letter of Medical Necessity 73 Return Policy for Non-prescription Shoes (Orthopedic Shoes) 74 Orthotic Disclaimer 76 Certificate of Medical Necessity Diabetic Therapeutic Shoes 77 Certification of Medical Necessity for AFO 78 Request for Certificate of Medical Necessity (CMN) from PCP 79 Certificate of Medical Necessity Reminder 80 Disclaimers 80 At Risk Foot Care Tissue Injury Disclaimer 81 Cortisone Injection Disclaimer 82 Patient Education Materials 82 Bunion Surgery 83 Prescription Custom Molded AFO Break-in Schedule 84 Compression Wrap Wear Instructions 85 Worker s Compensation 85 Worker s Compensation Patient Information 87 Forms for Medicare Beneficiaries 87 Notice to Medicare Beneficiaries about Coverage for Foot Care and Services 88 Medicare/Medicaid Authorization Assignment Agreement for Payments SECTION II PATIENT RELATIONS 89 A. Scheduling 89 Appointments 90 House Calls 90 B. Recall 90 Diabetic Shoe and Insoles Recall 91 Orthotic and Orthopedic Brace Recall 93 C. Insurance 93 Insurance Predetermination 93 Secondary Insurance 93 Guarantor Status for Minors/Patients under Guardianship 95 D. New Patient Processing
96 E. No Shows 96 New Patient No-shows 97 F. Patient Care outside the Practice 98 G. Prescription Refills 99 H. Resolving Complaints from Medicare Beneficiaries 100 I. Patient Relations Forms 100 Appointment Reminder 101 Medicare Beneficiary Complaint Log 102 Orthotic Recall Letter 103 Advance Beneficiary Notice (ABN) 104 Assignment of Benefits and Release of Medical and Plan Documents 105 Acceptance of Insurance Assignment and Financial Policies 107 Introduction Letter to Medical Practice 108 Notice of Privacy Practices 113 Authorization for Release of Information 115 Discharge Due to Missed Appointments 116 Patient Discharge Disclaimer 117 Discharge Letter Due to Other Situations SECTION III OFFICE ADMINISTRATION 119 A. Job Responsibilities 119 Office Manager Job Responsibilities 122 Licensed Practical Nurse/Podiatric Medical Assistant Job Responsibilities 124 Receptionist Job Responsibilities 125 Administrative Assistant Job Responsibilities 126 Accounts Manager Job Responsibilities 127 Medicare Specialist Job Responsibilities 128 Billing Specialist Job Responsibilities 129 B. Office Management Policies 129 Bulletins/Policies 129 Practice Policy Creation 130 Marketing and Public Relations 130 Special Events 132 Meetings 132 Clinical Meeting 133 Business Meeting 133 Responding to Telephone Calls 134 Placing Callers on Hold
134 Telephone Triage 135 Delays in Waiting Room 135 Office Cleanliness 136 Hand Sanitation 137 C. Financial Policies 137 Annual Budget 137 Accounts Payable (AP) 138 Durable Medical Equipment (DME) Accounts Payable 138 Storage of Accounts Payable Invoices 139 Business Taxes 139 Patient/Insurance Refund Checks 139 Accounts Receivable 139 Daily Deposits 139 Billing/Superbills 140 Explanation of Benefits (EOB) Processing 141 Patient Statements 141 Deceased Patients 141 Aging Analysis Reports 141 Medicare 142 Medicare Part B Claims Processing 143 Pre- and Post-submission Review 143 Deductibles 143 Collection Policies 144 Referral to Collection Agencies 145 Referral to Attorney 145 Financial Hardship 146 Coding and Fee Schedules 146 Public Assistance 147 Deposits 147 Deposits for Durable Medical Equipment 147 Non-covered Services 148 Insurance Information for New Patients 148 Billing Secondary Insurance 148 Cash Payments 148 Office Statistical Information 149 Coding 149 Medicare Coding 150 Year-end Activities 152 D. Administrative Forms 152 Insurance Assignment Acceptance 154 Authorization for Treatment and Release of Medical Information 156 Refundable Deposit Receipt 157 Request for Financial Hardship Status 158 Collection Letter
SECTION IV PERSONNEL POLICIES 159 A. Employee Break Periods 159 B. Educational Seminar/Travel Expense 160 C. Compensation and Benefits 160 Work Hours 160 Timesheets and Pay Periods 161 Unsupervised Work 161 Health Insurance 162 D. Time Away from Work 162 Vacation Time 162 Sickness/Disability 163 Unpaid Leave 163 Inclement Weather Days 164 E. Employee Cross Training 164 F. Employee Memos 164 G. Hiring Practices 165 New Employees 166 H. Behavioral Expectations 166 Smoking Policy 167 Telephone Usage 167 Uniforms/Work Attire 168 Office Cleanliness 169 I. Performance Evaluation, Recognition and Discipline 169 Evaluations 169 Employee Recognition 170 Discipline 170 Warnings 171 Observations 172 J. Employee Forms 172 Absence Request 173 Employee Warning Notice 174 Employee Performance Review 175 Payroll Disclaimer 176 Employment Agreement and Morals and Ethics Clause 177 Job Training Disclaimer SECTION V APPENDICES 181 Appendix A: Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards