APMA is deeply concerned by recent Office of Inspector General (OIG) reports addressing podiatrists’ claims for evaluation and management (E/M) services billed with modifier 25 and podiatrists' routine foot care claims. The reports, titled “Podiatrists’ Claims for Evaluation and Management Services Did Not Comply with Medicare Requirements” and "Podiatrists' Claims for Routine Foot Care Services Did Not Comply with Medicare Requirements," make a sweeping claims regarding podiatrists’ compliance. These claims fail to recognize the value of care delivered by our profession and are not reflective of care delivery and claims billing today.
While APMA fully supports efforts to ensure proper Medicare billing, the framing of the reports is troubling and risks creating a misleading narrative about podiatric medical practice. Podiatric physicians regularly perform procedures while also performing significant and separately identifiable evaluation and management services at the same encounter, making appropriate use of modifier 25 both clinically justified and common. The OIG’s finding that 44 out of 100 sampled E/M claims did not fully comply with Medicare requirements must be interpreted with great caution, particularly in light of the time that has elapsed since the services in the report were furnished.
We also underscore that sample-based extrapolations—such as the OIG’s estimate that roughly $39.6 million of the $222.5 million paid during the E/M audit period may not have complied with requirements—can easily overstate alleged improper payments. Such extrapolations also fail to capture the clinical nuance involved in day-to-day patient care.
An audit of 2019 data does not reflect how care is currently delivered, documented, or billed. Furthermore, CMS and its Medicare Administrative Contractors (MACs) have undertaken several initiatives in the intervening years to improve provider education and reduce improper payments.
APMA calls on CMS and the MACs to ensure that any additional oversight or educational efforts recommended by the OIG are transparent, supported by clear guidelines. They should also recognize and accommodate the clinical realities of patient care. APMA encourages its members to make use of the association’s 25 modifier and routine foot care resources to help ensure compliance with Medicare requirements. Visit our 25 modifier tool kit at www.apma.org/25modifier and take advantage of our E/M resources page at www.apma.org/EM. Find our Routine Foot Care and -59 Modifier Claims Tool Kit at www.apma.org/59toolkit, and check out a helpful infographic on routine foot care.
APMA remains committed to working collaboratively with CMS, OIG, and other stakeholders to strengthen documentation and compliance standards while protecting podiatrists’ ability to deliver timely, medically necessary care to millions of Medicare beneficiaries.