Specialty medical providers face a few more billing challenges than the average health clinic or practitioner. This statement is no more accurate than for those in the podiatry field. Prompt payment is ever-important, but medical billing for podiatrists can present challenges and risks for time-consuming billing audits. Many podiatrists have small-scale practices without many hours to dedicate specifically to billing to make matters challenging.
As a podiatrist, your practice offers treatment for conditions related to the feet and ankles. However, without careful consideration, the payer would consider your services to be medically unnecessary. Large payers like Medicare don’t cover anything billed as routine foot care.
Here are Podiatry Billing Tips to Overcome Medical Billing Challenges
Make Sure You Are Using Billing Modifiers Correctly
Modifiers help give a clear description of the podiatry services performed. This ensures you have accurate claims with no chances of denial. Including modifiers to submit the claims can help signify that services performed were not routine.
For example, you may be unable to bill for nail debridement unless you include a document that made the debridement necessary. For example, a Q7 or Q9 modifier with the debridement code would be billed when shown a part of a vascular diagnosis.
Do keep in mind, overuse of specific modifiers can be an issue. For instance, if you are consistently billing nail debridement with the same diagnosis codes and modifiers, you could see an uptick in claim denials.
Be Crystal Clear When Billing for the Use of New Diagnostic or Treatment Equipment
Diagnostic and treatment equipment can be necessary for your podiatry practice, and that equipment can be ever-evolving. Even if you use new equipment similar to what you used in the past, your billing codes may not be the same. Many podiatrists invest in new equipment and anticipate the billing in the same way, but it might not be the case.
Besides, the claim must be both reasonable and medically necessary to be approved as diagnostic or treatment equipment. The system could reject the claim because the chart’s terminology would mention it as screening and not evaluation of a specific problem. For example, a claim for diagnostic imaging equipment undergoes rejection when deemed screening and not an evaluation of a particular issue.
Follow the Protocols When Billing For DME
Durable medical equipment (DME), such as CAM (controlled ankle motion) walkers, can be a standard part of treatment processes in your podiatry practice. However, billing for DME dispensement can be tricky. You can run into issues if you do not have a physical order that states:
- What item are you dispensing to the patient
- Why that item is medically necessary
- The length of DME requirement to treat the condition
According to Podiatry Today, you need the receipt to be signed by the patient, when dispensing DME for prescribed treatment for reimbursement. The receipt should show DME dispensement, along with the instruction and relevant details for the patient.
Get Proactive About Claims Scrubbing
‘Unclean’ claims have a higher probability of rejection. When you submit a good, clear claim, the billing process goes smoothly, and you get paid for the first claim submission itself. Claim scrubbing involves using electronic tools to scan for and detect improper attributes of billing for podiatrist practices. The claims scrubbing tools help deter human error, which is not uncommon.
The average cost for reworking on claims is $25. You could be losing $2,500 for 100 rejected claims. Lack of knowledge or time for updating the claims accounts for 50 to 65 percent of denied claims.
A good claim scrubbing process will ensure no claim rejections. You should have a protocol to follow when rejected claims happen. Otherwise, you are leaving unclaimed money up in the air, with a limited time to get your funds.
Go over the protocol for handling a rejected claim with the staff in charge of medical billing in your practice. Be sure the billing professionals in your office know the podiatry billing tips to negate issues with rejections. Additionally, if you have an excellent EHR solution in use in your podiatry practice, you’ll be alerted to rejected claims quickly. Plus, you can utilize data analyzing reports to find out how many rejections you may have to rework at any given time.
Podiatry Billing May Be Challenging, but Good EHR Solutions Can Help
When you practice in such a specialized field that can come with so many complexities for billing, you need help. Investing in the right EHR solution can make a difference in making your podiatry billing efficient. If you are interested in a cloud-based EHR for medical billing software for your practice, take a look at PrognoCIS EHR solutions.