12/21/2023

Podiatry Services for Residents in a Group Home

I have been asked to provide podiatry services to a group home system with over 90 residents. The residents are all on Medicare and ages range from 20 to 80. The administrators want me to bill Medicare for the services I provide "like all the other podiatrists have". Does Medicare permit blanket coverage of podiatry services for residents of group homes or am I putting myself at risk for billing routine podiatry services for 25 year old patients with autism who can not cut their own nails? What are my options?

Services should only be provided to the residence if there is a medically necessary reason to be seen by a podiatrist. A physician or nurse that routinely assesses these residents should be the gatekeeper for patients who need routine or acute care to prevent unnecessary encounters. These referrals from other medical professionals should be the basis for performing care on patients who need specialist care. Having the referrals, along with medically necessary documentation can justify the need for care that should not put a provider at risk.