Podiatry Billing: Challenges and Solutions
The diagnosis and treatment of diseases, wounds, and deformities of the human foot are the focus of the medical speciality of podiatry. Podiatric medicine deals with the diagnosis, medical care, and surgical treatment of lower leg and foot conditions. Treatments for the feet that are mechanical, physical, medical, and surgical are also included in this speciality.
Podiatry billing can be challenging in a variety of ways, from the subtleties of coding to the requirement to establish and support the treatment's medical necessity. Additionally, since Medicare covers this demographic, podiatrists typically treat the elderly, necessitating additional billing and coding efforts. Modifier usage must be exact, and coding for inclusive operations must be understood.
Podiatrists frequently employ internal teams of coders or outside billing organizations that advertise their competence with podiatry billing. Many of these services frequently lack the knowledge necessary to regularly track, record, and resolve outstanding or underpaid claims. As a result, podiatrists are forced to switch to outsourcing their billing and coding requirements to reputable and effective billing businesses with experience in the field. One of the first companies to offer billing and coding services for podiatry is OneMed Billing Services. By identifying and fixing the main problems with podiatry billing and coding, we can reliably increase collections by over 35% and decrease denials by over 18% with the help of seasoned resources and institutionalised best practices.
Important Considerations for Podiatry Medical Coding and Billing
1. Prior Authorization: Podiatry claims often require prior authorization for reimbursement. Rejections are common, and claims must include the authorization number and secure approval from the payer.
2. Medicare Referring Provider Codes: When billing for Medicare, referring provider codes must follow CPT codes to ensure accuracy.
3. Coding Accuracy:Correct coding is crucial for clean claim submissions. Providers may bill for additional procedure codes separately, following payer policies.
4. Medical Requirement:Proper coding using appropriate CPT and diagnosis codes in line with standards is essential. Documentation should confirm LCD and NCD (National Coverage Determinations) as well as attest to medical necessity for services and treatments. Strong documentation helps appeals for unpaid claims.
5. Comprehensive Services: Claims are often rejected for inclusive procedures. Providers should not bill CPT codes 11719, 11721, and G0127 together to avoid comprehensive denials. Insurance companies should be appealed with necessary medical records if the claim is denied despite proper modifier use and checking CCI modifications.
6. Regularity of Service: Regular foot care is medically necessary every 60 days. Payers will refuse frequent services within 60 days, so providers must submit necessary medical documentation to contest reimbursement claims.
7. Q Modifiers:When submitting claims with Q modifiers, findings related to the patient's condition must be indicated. Podiatry services use Q7, Q8, and Q9 modifiers. Medical coders may use q modifiers with procedure codes 11055, 11056, 11057, 11719, 11720, 11721, or G012.
Professional Podiatry Billing and Coding Services for Efficient Revenue Cycle Management
At our company, we specialize in podiatry billing and coding services to ensure a successful and denial-free revenue cycle management process for our clients. Our team of podiatry billers and coders is dedicated to maximizing your collections while helping you prioritize top-notch patient care. Here are some of the reasons why you can trust us with your medical coding and billing needs:
1. CPC Certification: Our team members hold the CPC certification from the American Association of Professional Coders, providing them with training in most medical coding software.
2. Experience with Commercial and Government Payers: We have successfully processed medical claims with various commercial insurance providers, including UHC, WellPoint, Aetna, Humana, BCBS, and Anthem, as well as government payers like Medicare.
3. Understanding of Medicaid Policies: Our team is well-versed in Medicare policies and has a thorough understanding of Medicaid policies unique to each state.
4. Cost Reduction Experts: We are experts in cost reduction and can assist you in improving clinical and operational efficiency.
5. Dedicated AR and Prior Authorization Teams: Our teams for AR follow-up and prior authorization ensure that comprehensive patient data is gathered, reducing the likelihood of claim denials.
Choose our professional podiatry billing and coding services for efficient and effective revenue cycle management.