Podiatry Billing and Coding – Strategies for Success

Podiatrists may have to deal with diverse foot conditions – chronic or acute. Not all services are reimbursable. Most services related to the foot are based on medical necessity requirements, and this makes podiatry coding and billing rather complex.

Key strategies involved in podiatry billing include:

Insurance verification

Podiatry billing process begins with insurance verification. Most insurance claim denials occur due to lack of verifying insurance benefit information prior to services being provided. Health insurance verification refers to the process of checking a patient’s active coverage with the insurance company and verifying the eligibility of his or her insurance claims. As insurance details can change at any time, even for regular patients, it is important for providers to verify their patient’s insurance eligibility each and every time services are provided.

The most common reasons for denials are – coverage is terminated, the services provided are not covered or maximum benefit for this service has been met. It is critical for podiatry practices to verify all details such as – Payable benefits, Deductibles, Co-pays, Co-insurances, Type of plan and coverage details, Plan exclusions, Patient policy status, Effective date and Insurance name, phone number and claims mailing address.

An experienced podiatry billing company follows certain key strategies in their eligibility verification process such as – patient enrollment, verifying eligibility and benefits, obtaining authorizations, contacting patients and then updating the billing system.

Accurate medical codes and correct modifiers

Accurate medical coding is an important requirement for clean claim submission. More specific ICD-10, CPT and HCPCS codes should be used to report diagnosis and treatment provided to prevent claim denials and ensure appropriate reimbursement. Incorrect coding will impact your practice’s revenue. Certain multiple procedure codes can be listed for one operative note, while some of them may be considered as part of the more complex procedures being performed. Based on specific payer requirements, separate procedure codes can also be billed with other codes. Careful review of all the codes in this range is recommended before choosing the final code for any podiatry procedure. Medical coders should also be up to date with the changing coding standards in podiatry specialty.

Modifiers provide additional information to payers to make sure the provider is paid correctly for services rendered. If appropriate, more than one modifier may be used with a single procedure code; however, they are not applicable for every category of the CPT codes. Some modifiers can only be used with a particular category and some are not compatible with others.

Optimize accounts receivable (A/R)

Accounts receivable (A/R) refer to the money your practice owes. Write-offs of unpaid balances and denied claims after a period of time, without exploring alternative payment options can lead to high A/R. Evaluating A/R is crucial to manage any practice’s revenue cycle and address any issues preventing timely payments.

To optimize A/R management, billing specialists should – have a clear idea regarding how each payer’s specific guidelines affect the practice’s A/R management, know how to establish contact with each payer to help resolve problems faster, analyze reimbursement trends by payers on a monthly basis, file claims on the day of service and implement a strict collections policy for patient accounts. Professional medical billing companies can help practices dramatically reduce their accounts receivable cycle and increase revenue.

Timely appeals of claims

In case of a claim denial, carefully read the explanation of benefits (EOB) and check the remark codes to know why the carrier denied the claim. This will give you the basis for your appeal. While some claims actually need formal appeals, others may require only simple corrections. While appealing, ensure that the correct podiatry form is filled. Consider including the word “appeal” in the title and the text of the document and in any cover letter that is attached with the appeal document. After submitting the appeal, it is important to call and confirm that the insurance company has received the appeal, or review the submission online. Also, follow it up in 30 days.

Collect co-pays

Co-pays make up a large portion of your practice’s revenue. Front office staff must be instructed to collect co-pays upfront from every patient, when they come in for their appointment. This is essential for the success and growth of the practice. Also, have an established financial policy in place. Patients should be made aware of the payments when scheduling appointments; make them sign a form acknowledging that their insurance may not cover all of their care.

Choose a podiatry billing company that is specialized in podiatry, as they will help your practice to deal with all strategies related to billing and coding. They can also deal with claims rejections, billing disputes and other billing issues.