As your podiatry practice grows, you may start to wonder about outsourcing your billing to a third party. It’s easy to feel overwhelmed by the process of outsourced billing and the options available to you. We should not forget that the delivery of health care is also a part of the industry that needs our attention. From a business standpoint, having a smooth and efficiently run practice allows you to concentrate on patient care.
Let’s walk through that process step by step. That way, you’ll have a better understanding of the podiatry billing process and feel more confident in the option you choose.
We’ll look at the most common insurance types, coding, and whether or not outsourced billing is right for your practice.
4 TYPES OF INSURANCE FOR PODIATRY BILLING
There are 4 major types of insurance carriers that are likely to insure your patients.
1) The HMO: Health Maintenance Organization
An HMO is a very cost-effective health care plan. People who join an HMO pay a fixed annual fee for comprehensive health care.
These plans may include preventative care. Patients who are insured by HMOs are restricted to use only the individual plan’s network of providers. Many of the services covered by an HMO require preapproval.
2) The PPO: Preferred Provider Organization
Like an HMO, a PPO has a preferred network of providers. Patients can, however, choose to go to a provider outside of their network. When they elect to do so, they must pay the difference between the network doctor’s fee and the cost of the doctor not covered by the plan.
A PPO costs the patient and their employers a bit more than an HMO plan.
3) The POS: Point of Service Plans
The final type of non-Medicare insurance carrier is a POS plan. This plan is generally described as a hybrid of the HMO and PPO type of plan.
Members of a POS plan can use out-of-network doctors like those with PPOs can. However, when they do, they have reduced levels of benefits. For example, in utilizing a plan’s network doctor, the patient may have 100% coverage; going out of network, they may only have 70% coverage.
4) Medicare or Medicaid: Government Funded
The final and most common types of insurance carriers that you will likely deal with are the Medicare/Medicaid plans. Medicare and Medicaid are federal and state-funded programs.
What’s the Difference?
Medicare insures the elderly and those who are disabled, while Medicaid insures those whose income falls below a certain threshold.
Unlike the HMO or POS plans, patients do not need primary care referrals to see podiatrists. The Medicare fee schedule is published annually, and Medicare pays 80% of the allowable fee. Either the patient or the patient’s secondary carrier is responsible for the remaining 20%.
Medicaid also has a set fee schedule. The Medicaid fee paid is generally lower than Medicare, and billing the patient any balances is prohibited.
INSURANCE COMPANY POLICIES IN PODIATRY BILLING
All health care plans have an established fee schedule that you should obtain at the beginning of each fiscal year. Simply put, the fee schedule is a listing of accepted fees and allowances for specific medical procedures. It usually represents the maximum amount that the program will pay for the specified procedure.
Members who are part of a managed care plan often have what’s known as a co-payment. This is a small fee the patient must pay at the time of service to a physician.
Co-payments are designed to discourage overutilization of health care services, as those $10 or $20 payments per visit add up for patients.
Coinsurance is the amount of the fee in percentages that a carrier pays. This leaves the patient or a patient’s secondary insurance carrier with the balance. Many patients will subscribe to a secondary insurance plan to help fund this balance. If they don’t have a secondary plan, the patient is liable for that balance.
Many plans (including Medicare) have an annual amount of money that a patient must pay out of pocket before their insurance benefits are initiated. This is known as a deductible. At the beginning of each year, it’s important to educate your patients about their deductible. Attempting to collect payments in a timely manner will help in avoiding a cash-flow crunch.
Following the service, a patient receives a comprehensive document. This is known as an Explanation of Benefits, or EOB. The EOB discloses what fees were allowed, what the physician was paid for that service, and what the patient’s financial obligation is.
WHAT YOU SHOULD KNOW ABOUT PODIATRY CODING AND BILLING
Some of the most important employees you have in your practice are those who do your billing and collections. If you have only one employee responsible for a particular task or set of tasks, that employee is “holding all the cards” at salary review time. In addition, the only supervision this employee has is you.
Close personal review of everything that goes on in the office is almost impossible. In business, it is best practice to have a handful of employees cross-trained in all areas to protect your practice from schemes and embezzlement.
When hiring and training your billing staff, you should consider that podiatry coding is a continually changing field. You (as the physician) and your billing staff must continue to update yourselves on changes in billing codes and procedures.
Doing so will keep you out of trouble and help you take advantage of new opportunities. Plus, correct billing for services you perform will increase your potential profits.
IS OUTSOURCING THE ANSWER TO THE PODIATRY BILLING PROCESS?
Many physicians look at outsourcing as an optimal solution, as it curbs some of the issues mentioned above. Selecting the best billing service to use is paramount.
Here is a list of some questions you can ask of prospective billing services. These questions can help you decide if outsourcing is for you and assist you in finding the right one for your practice.
Does the billing service in question deal exclusively with podiatry?
Although it isn’t necessary for them to deal exclusively with podiatry, it is helpful if a large percentage of their business has a great understanding in that field. This ensures that they will be up to date on insurance and coding changes within the field of podiatry.
What are the service fees? What do they include? Is there a start-up charge? If so, how much?
These answers will help you make the decision whether or not it is financially worth it to outsource your billing. It’s important to keep in mind that most billing companies charge a percentage of the monies collected. Obviously, this would exclude money that comes through the office for things such as co-pays, lotions, creams, wound dressings, etc.
Is there a minimum amount for which the company will send a statement?
Knowing the answer to this question will enable you to plan your billing process accordingly.
How does information transfer between the practice and the service? How do the encounters transmit to the service (mail, fax, delivery service, or scanner)?
Obviously, it will be best if whatever method they use is compatible with your office and staff.
How does the practice access the information on each account? Is the information online? Can you download the financial information, or do you have to go to the service’s website to access the information?
Knowing beforehand how accessible the information will be to you and your client will lead to fewer headaches down the road and better client satisfaction.
Who handles the money?
All checks provided by both the insurance company and patient should go to the practice, not the billing service. The billing service should not handle any money. This protects both the podiatry practice and the billing service.
MAKING FINAL DECISIONS ON YOUR BILLING PROCEDURES
Overall, outsourced podiatry billing is not for everyone, and the best approach to take is a logical one. Calculate what you are paying now. Decide what involvement you, your partners, and your billing staff are comfortable with. Then find a knowledgeable billing company with positive reviews that handles mostly podiatry claims.
When making this decision, don’t forget to factor in security, office harmony, and peace of mind that your billing process is reliable and equipped with all of the latest insurance and billing changes.