post image

The Essential Guide to Podiatry Medical Billing with Eminence RCM

If we look closely at the current healthcare landscape, one thing is understandable that streamlined and successful billing processes are essential for medical specialties including podiatry. However, when we get into podiatry medical billing and coding, it puts unique challenges because of the specialized nature of podiatry services. The intricacies involved in coding and billing for this field hamper the task of podiatry medical billing.

The main part of consideration for Podiatrists is diagnosing, treating, and preventing foot, ankle, and lower extremity conditions. This necessitates the adoption of effective podiatry medical billing practices to streamline the revenue cycle of various healthcare organizations. The practical strategy is to rely on a knowledgeable medical billing company to maximize revenue and minimize claim denials in podiatry practices.

Let’s dive into an essential guide to Podiatry Medical Billing and learn the best practices to address every challenge of the specialty.

Podiatry Medical Billing

Podiatry or podiatric medicine includes the diagnosis, medical, and surgical treatment of disorders related to the foot, ankle and lower extremities. With the heavy use of modifiers, global periods, complex inclusive procedures and other challenges, Podiatry medical billing can be a complex task. However, it is the most crucial aspect of running your podiatric practice smoothly.

The process of Podiatry Medical Billing involves submitting accurate claims, managing reimbursements, and navigating the intricacies that arise during the process of claim submission.

The point here is that there are several common issues that can arise during the podiatry billing process. This leads to financial loss and adds to the administrative burden.

In the following information, we have gathered the top issues with podiatry medical billing. Along with that we will emphasize the importance of hiring a medical billing expert to mitigate the challenges effectively that arise in the process.

Most Common Challenges in Podiatry Medical Billing and Coding

Hereunder are the key challenges that contributes to the complexities of Podiatry Medical Billing:

Specific coding-related requirement

Like any other specialty, Podiatry also has its own set of specific coding requirements. Podiatrists are the specialists who diagnose and treat a vast range of foot and ankle conditions. It includes fractures, sprains, infections, sports injuries, diabetic foot complications, deformities and others.

These specialists perform treatments which are different from other specialties in healthcare.

For example:

  • Hammertoe corrections, Achilles tendon repairs, ankle arthroscopy, bunionectomies, joint fusions and more.
  • It also includes non-surgical treatments like orthotics, physical therapy, wound care
  • Assessment of the biomechanics of the lower extremities to identify abnormalities in foot structure.
  • Management of complications in foot concerned with diabetes
  • Treatment of Foot and ankle sports injuries
  • Coordinated care for foot and ankle conditions connected to systemic diseases
  • Preventive care to minimize the occurrence of foot problems

While billing all these procedures and treatments correctly, it is essential to ensure compliance and accurate reimbursements.

Compliance with guidelines in coding

There are various coding guidelines set by the Podiatry coders must adhere to coding guidelines set by organizations such as the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS). Your healthcare organization must adhere to that. It can be quite a challenging task to stay up to date with coding guidelines. Also, ensuring compliance can be challenging, especially with regular updates and changes.

When we specifically talk about podiatry, coders need to be familiar with the podiatry-specific CPT and ICD-10 codes to carry out the entire billing process smoothly. One point to consider is that it is possible to use multiple modifiers with a single procedure code, if required. Although not all modifiers are applicable to every category of CPT codes. Take care of the fact that certain modifiers are exclusive to specific categories, while others are not compatible with certain modifiers.

Insurance coverage and reimbursement

As podiatry practices primarily treat elderly people, this necessitates additional efforts in billing and coding. This is because the population is covered by Medicare. There is a possibility that private insurance companies and Medicare have specific policies and guidelines for podiatry services.

For instance, routine foot care services are subject to national regulations. This provides definitions, indications, and limitations for Medicare payment of routine foot care services. It can be challenging to understand these policies and ensure proper documentation to support medical necessities. Reimbursement rates for podiatry services may vary accordingly. This means that coders need to be knowledgeable about insurance plans to optimize reimbursement.

Challenges in Documentation

For proper coding and billing in podiatry, it is necessary to ensure accurate and comprehensive documentation. It is important for the Podiatrists to provide a detailed and specific documentation of patient encounters, procedures performed, diagnoses, and medical necessity. If the documentation is incomplete or inadequate, it can lead to claim denials, delays in reimbursement, and potential compliance issues.

One important thing to consider is that it is essential to document all relevant information, including the patient’s chief complaint, history of present illness, examination findings, treatment plan, and other necessary details.

There are various services provided by Podiatrists that may not be reimbursable. The determination of medical necessity and validation of coverage is critical to getting reimbursed in an optimal manner. For instance, if you are to bill nail debridement, it is important to furnish supporting documentation that demonstrates the importance of the debridement procedure.

Complex rules and regulations of medical billing

Medical billing and coding are subject to numerous rules and regulations. These include every rule in coding guidelines, documentation requirements, submission of claims, and reimbursement processes. It is important that you are well-educated about those ever-changing rules and regulations to avoid coding errors and billing denials.

Reimbursement denials and appeals

Due to the complex nature of podiatry coding and billing, claim denials are quite common. The reasons for denials can be due to coding errors, insufficient documentation, or the policies of the insurance company. The process of resolving denials and navigating the appeals can be quite time-consuming and demands a deep knowledge of insurance policies and regulations.

Best Practices for Maximizing Podiatry Practice Reimbursement

For ensuring the financial success of your practice, it is important to implement the best practices in podiatry medical billing. Let’s discuss a few of them:

Proper coding and documentation process

The foremost step is to ensure that the reimbursement of a healthcare organization accurately reflects the services provided. The process includes documenting the chief complaint properly, a detailed history of the present illness, findings in the examination, proper treatment plan, and any other relevant information available. When the documentation is detailed, it helps to establish medical necessity and supports the codes that are billed. Advanced EHR systems help to streamline the documentation process and ensure consistency and accuracy.

Report the appropriate CPT codes

The second step is to make sure that you are familiar with the specific coding guidelines for podiatry services. If you want to maximize reimbursements send ensure compliance, it is important to stay updated with the coding changes and guidelines. Make sure that you know the commonly used CPT codes for podiatry billing.

Know the requirements of prior authorization

Another important thing for podiatrists and their staff is to be familiar with the specific requirements of prior authorization requirements of different insurance plans. This is done to ensure timely approval and minimize the chances of reimbursement issues.

If we talk about 2023, most podiatry services (Medicare, Medicaid and commercial) didn’t require an authorization.

Only the following services require authorization:

  • Certain injections for pain management
  • HBO therapy
  • Physical therapy

It would be advisable to verify if precertification is required, if a podiatrist renders services in a hospital, ASC, home, or other POS.

Compliance considerations

Non-compliance with the rules and regulations can lead to penalties, fines, and long-term damage to the reputation. When regular audits are conducted, it can help identify any potential compliance issues such as coding errors, documentation deficiencies, and other areas that are non-compliant. It is important to address any issues as soon as possible and implement corrective measures accordingly. Staying up to date on changes in billing regulations and guidelines ensures ongoing compliance with the regulations.

Until now, you must be well-versed with the challenges and best practices of podiatry billing. Overcoming these challenges and implementing best practices is essential for the financial success of your podiatry practice. Strategies that must be considered include investing in ongoing training and education for coders and implementing effective documentation improvement programs. You can also leverage technology and software solutions for coding and billing.

Practices can also consider medical billing outsourcing to an expert like Eminence RCM who is proficient in the field of podiatry. When you partner with an expert, it can help practices optimize their billing operations, avoid denials, increase revenue, and make a way for sustainable growth of your healthcare practice.

Schedule Demo