Insurance companies set billing rules and finance the healthcare industry. These ever-changing regulations make medical coding and billing difficult for healthcare providers, including podiatry clinics.
Podiatry coding and billing services are made more difficult by the medical necessity and restrictions associated with foot care. Outsourcing these tasks to a business process outsourcing (BPO) company can help podiatrists make the most of their reimbursements.
Learn an understanding of podiatry billing and coding, as well as the factors that go into reimbursement. You will also gain an understanding of procedural services, the reasons why podiatrists should outsource medical billing and coding, as well as the steps necessary to locate a reliable external medical billing provider.
What Is Podiatry Billing?
Podiatrists treat foot disorders and injuries. Foot, ankle, and lower-leg diseases are diagnosed, treated, and fixed with surgery by a podiatrist. There are treatments for the foot that are therapeutic, surgical, mechanical, and physical.
Medicare does not cover the following services because it considers them routine:
Cutting or removing corns and calluses
In the absence of localized illness, injury, or symptoms affecting the foot, ambulatory or bedfast patients can use foot washing and soaks, skin creams, and other treatments.
From determining medical necessity to coding, podiatry billing and coding can be difficult. Because Medicare covers the elderly, podiatry clinics must bill and code extra. Modifiers and inclusive procedure coding are essential for podiatry rcm.
Podiatrists can hire in-house coders or use an experienced billing service. Medical billing providers must be able to track, document, and resolve unpaid claims.
Collections can rise 25% and rejections fall 23% with best practices and experienced podiatry coders.
Innovative Technologies and Strategies that Maximizing Reimbursement in Podiatry Billing
EHR and Practice Management Software:
Strong EHR and Practice Management Software streamlines billing and improves accuracy. EHR systems with integrated billing enable claim generation, electronic submission, and real-time tracking. This reduces errors, speeds billing, and expedites reimbursement.
Automated Eligibility Verification:
These tools instantly verify patients’ insurance coverage and benefits. By verifying insurance before the appointment, podiatry practices can avoid claim denials due to eligibility issues and inform patients of their financial obligations.
Coding and Documentation Optimization:
Correct coding and thorough documentation maximize reimbursement. Advanced coding software can help podiatrists choose the best CPT and ICD-10 codes for services, reducing errors and increasing claim acceptance. Encouraging detailed documentation supports medical necessity and ensures adequate reimbursement for all services.
RCM Solutions:
Outsourcing RCM to specialized billing companies can transform podiatry practices. Advanced analytics help RCM companies optimize revenue cycles, identify revenue leakage, and analyze billing data. Using their expertise, podiatrists can focus on patient care while improving billing and reimbursement.
Podiatry practices can use sophisticated denial management solutions to reduce claim denials and appeal rejections. These tools help the practice identify patterns in denied claims and fix them. Preventing claim denials boosts reimbursement rates and cash flow.
Telehealth Billing:
As telehealth becomes more popular, podiatry practices can reach remote patients. Telehealth billing solutions ensure proper coding and billing for virtual visits, maximizing reimbursement.
Compliance and Audit Support:
Podiatry practices must follow ever-changing billing regulations to avoid costly penalties and audits. Compliance tools and services keep practices compliant and prevent revenue losses from non-compliance.
Patient Payment Solutions:
Online payment portals and payment plans improve patient satisfaction and payment timeliness. Convenient payment options reduce accounts receivable days and ensure prompt service reimbursement.
What Influences Podiatry Reimbursements?
There are a number of grounds on which insurance companies may reject podiatric claims. For example, a payer may no longer cover certain services or may have already paid out the maximum podiatric claim benefit.
Some of the most important aspects of podiatric service reimbursements include:
Prior authorization
Podiatry clinics frequently receive denials. They must follow insurance provider guidelines and formats to get prior authorization. They can submit their claim and authorization number after insurance approval.
Medical need.
Coders must understand diagnosis and CPT codes. They apply NCDs and LCDs. Medical necessity is essential to medical claims. Coding should support the medical necessity of podiatry services.
Coding accuracy.
Successful claim submission requires accurate medical coding. If the healthcare provider’s payer allows it, the healthcare provider may submit claims for additional procedure codes.
Inclusive methods.
Due to inclusive procedures, insurance companies usually deny claims. To avoid inclusive rejections, healthcare providers should not bill CPT codes 11719, 11721, and G0127 together.
The biller can appeal and use medical documents and Correct Coding Initiative (CCI) amendments to review a claim denied by an insurance company even with the modifier.
Repeated service. Foot care is medically necessary every 60 days. Within 60 days, payers reject frequent services as unnecessary. Medical records can be submitted as an appeal by the biller.
Why Should Podiatrists Outsource Medical Billing?
Outsourcing improves employee and patient care. A podiatrist treats foot and ankle issues. Podiatrists struggle with billing and coding daily.
The medical necessity and restrictions on foot conditions make podiatry billing and coding easier for external providers. It is a waste of time for podiatrists to learn which insurance providers cover which services, which codes to use, and to submit clean documentation.
These tasks are essential to ensure that reimbursements are maximized. Professional billers and coders are capable of doing a better job at a fraction of the cost, allowing podiatrists to devote their attention solely to the treatment of their patients.
When a podiatry clinic contracts out the provision of its medical recovery services, it will be able to obtain comprehensive performance reports from the external team to promote openness and honesty in its business practices. This is absolutely necessary to ensure the success and longevity of a podiatry practice. Billing operations can be better understood with the help of insights from external medical billing companies.
The Bottom Line
Podiatrists diagnose, treat, and prevent foot and ankle problems. Podiatrists treat only medically necessary foot conditions. The reimbursements these medical experts receive are contingent on their familiarity with what is covered, their use of appropriate codes, and the tidiness of their records. Outsourcing podiatry billing and coding eliminates these tasks.
Billing and coding companies for podiatry can process claims, verify benefits eligibility, transmit claims, and monitor accounts receivable.
Professional coders and billers should update their documentation for regulatory changes. To maximize benefits, choose a podiatry billing agency with billing and coding expertise.
Also Read: Innovative billing strategies: What you can do to ensure your clients pay you on time
