Podiatry billing is complex for several reasons. Many procedures are medically necessary in some instances and not others, and in some cases, each insurer has different rules for them. Issues with the feet and ankles become more frequent with age, so an aging population results in an increasing number of patients who are covered by Medicare—which means an additional set of coding and rules comes into the equation.
Payers are cutting what they are willing to pay and it can be especially confusing for patients when coverage changes from year to year. Fortunately for medical practices, outsourcing medical billing and coding is becoming the norm, and Medcare MSO is a reliable and highly effective provider of these services.
Medical Billing and Coding Are a Challenge for Podiatry
Podiatry is subject to some of the most varied coding issues of any medical specialization. Here are a few of the bigger challenges we have identified:
Coding not distinguishing medically necessary from routine:
Payers won’t cover routine foot care, but in podiatry there are instances in which the same condition may require medically necessary treatment for one person and not be a serious concern for another. Coders need to be experienced with the specialization in order to make the appropriate notation on the claim.
Inconsistent use of modifiers by payers:
Modifiers are subcategories of coding that give the details of a diagnosis or treatment, and they often determine whether it is covered or not. In podiatry, insurers have different rules for modifiers from each other, making it necessary for coders to know what each company uses to make determinations about what is covered.
Insurers bundling procedures inappropriately:
Payers like to bundle procedures into one coded item to make billing and payment simpler; however, there are times when bundling results in inaccurate billing or under- or over-coding. Billers must understand the procedures being performed so that they can determine when bundles are incorrect and they must know how to enter the data correctly, and how to handle the appeal when the insurer’s requirements result in non-payment.
Location changes affect billing:
The fact that podiatric procedures are commonly performed in offices, hospitals and nursing homes can add complexity to billing. Payers have different rules for each, and modifiers must be consistent to indicate where any given procedure was performed, or the claim may be denied. Likewise, an incorrect code elsewhere in the patient’s chart may indicate an incorrect location, resulting in a conflict which will get the claim rejected until all details are in order.
Outsourcing Podiatry Billing Services to Medcare MSO Puts Your Revenue Management in the Hands of Experts
Payers cutting down on amounts they will pay has strained the finances of many podiatry practices, making it necessary to ensure that every service provided is reimbursed. Meanwhile, running a practice demands that your attention be on providing outstanding care to patients, not on billing. Outsourcing medical billing and coding has proven to be the solution for many practices.
Medcare MSO’s certified specialists have years of experience in podiatry and receive ongoing training updates to keep them informed of the latest coding changes. Our innovative software makes coding simple and aligns your front office and our billing staff to ensure the most efficient process possible.
Billing services we provide start with patient scheduling and include day to day coding and submitting claims, but we also take care of managing denials and rejections, compliance charting and coding, annual payer adjustments and payback, and bill collection. Our processes are so effective that clients tell us we increase their revenue so much that they don’t consider out services a cost. Get a free demo today and let us show you how we can take billing off your plate and increase your revenue.