As podiatry medicine is quite different from other specialties, it is essential for billing professionals to know how to address the complexities in the field. Whether it be coding for a complicated foot surgery or for billing something routine. There is greater emphasis on claim follow-up and reimbursement to ensure that you get enough cash flow.
The Podiatry revenue management has mostly been an area of concern and confusion because of the medical necessity requirements from Medicare and various insurance carriers. Maximum number of these insurance carriers would reimburse for the treatment of conditions on foot and not for its preventive care. Some insurance carriers, for example, would not cover foot care without any visible symptoms. This has led to bigger confusion and hurdles in treatment and CPT coding of foot conditions.
Non-covered benefit for foot care
Routine foot care which do not show any symptoms is included in the non-covered benefits. Under routine care which is not covered, coverage of nails, bunions, calluses, corns, planter keratosis comes under it along with various other maintenance care for ambulatory or bed-confined patients. Even though, there are scenarios, like in the case of foot care for precise conditions, which results in sensory loss, thrombophlebitis, the systemic disease must be of acute severity whose non-professional treatment might be risky for the patient’s health.
Podiatry billing challenges
In order to get paid by podiatry billing, you often require the particular patient diagnoses and modifiers. Besides that, the tough part is in ensuring that the evaluation and management codes are separately reimbursed rather than bundled together for a single payment. Therefore, you need to improve your on-time processing.
Many practices need to upgrade their billing expertise to properly track and follow-up insurance underpayments. It is believed that underpayments cost podiatrist around 10% of their probable income. Complexities of medical billing includes patient billing, which means the billing specialist often has to interact with patients. It is crucial to understand that the cash flow depends on payments from patients who struggle understanding explanation of benefits and podiatry terminology.
To gain more knowledge, attend this audio session by Lynn Anderanin, CPC, CPPM, CPC-I, COSC, who will review the procedures relative to a podiatrist and what the documentation should be to substantiate these procedures. Lynn will review the services the podiatrist routinely performs, and if they can expect reimbursement from the insurance company.
