The word “audit” can strike fear into the hearts of healthcare providers, and podiatrists are no exception. Billing audits are a reality of the healthcare landscape, and being prepared is your best defense. Below, the team at A Step Above Health Management will guide you through the essentials of audit preparation and response, helping your podiatry practice navigate the process with confidence.
Common Audit Triggers in Podiatry
Several factors can increase the likelihood of an audit for a podiatry practice:
- High Utilization of Certain Codes: Unusually high billing for specific procedures compared to peers may raise red flags.
- Routine Foot Care Billing: Medicare closely scrutinizes routine foot care services, making accurate documentation and adherence to Local Coverage Determinations (LCDs) crucial.
- Diabetic Foot Care: Due to the complexity of diabetic foot care and its associated costs, this area is often subject to audits.
- E/M Coding Patterns: Consistent use of higher-level evaluation and management (E/M) codes than your peers may trigger an audit.
Proactive Preparation: Your Best Defense
Don’t wait for an audit letter to arrive. Take these steps now to ensure your practice is prepared:
- Internal Audits: Conduct regular internal audits of your coding and billing practices. This helps identify potential issues and allows you to correct them proactively.
- Meticulous Documentation: Accurate and thorough documentation is your most valuable asset during an audit. Ensure your records clearly support the medical necessity of services billed.
- Stay Current: Coding and billing guidelines change frequently. Stay informed about updates from Medicare, Medicaid, and other payers.
- Compliance Plan: Implement a comprehensive compliance plan that includes policies and procedures for coding, billing, and documentation.
Responding to an Audit: A Step-by-Step Approach
If you receive an audit notice, don’t panic. Take these steps:
- Understand the Scope: Carefully review the audit letter to understand the specific codes, dates of service, and issues being reviewed.
- Gather Documentation: Collect all relevant medical records, billing records, and supporting documentation.
- Organize and Review: Organize your documentation in a clear and logical manner. Review each record to ensure it supports the services billed.
- Cooperate, But Protect Your Rights: Cooperate fully with auditors, providing them with the requested information in a timely manner. However, be aware of your rights and don’t provide more information than requested unless upon further review.
- Seek Expert Help: Consider consulting with a certified coding specialist experienced in audit response.
Appealing Audit Findings
If the audit results in unfavorable findings, you have the right to appeal. The appeals process varies depending on the payer but generally involves multiple levels of review. Having an expert on your side can help your chances of success.
We can help you avoid billing errors. A Step Above Health Management provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save you money and help streamline your billing process.
Providing routine foot care for diabetic patients is a crucial aspect of podiatry, but navigating the billing complexities can be a challenge. One example? Proper use of G codes and Q modifiers, both of which are essential for ensuring accurate reimbursement and avoiding claim denials.
In this post, the team at A Step Above Health Management will break down the key elements of G and Q modifiers and help you stay ahead of potential issues that could slow down or complicate your practice.
Understanding G Codes for Routine Foot Care
Medicare uses specific G codes to identify routine foot care services for diabetic patients. The most common among them include:
- G0245: Initial physician evaluation to determine the need for routine foot care. This is generally a one-time code. The date of this visit will determine when the patient is eligible for routine foot care.
- G0246: Routine foot care, including care of nails, calluses, and corns, for a patient with a qualifying systemic condition. This code can be used for every visit where routine foot care is performed. The frequency of visits is generally every 61 days.
- G0247: Debridement of mycotic nails when performed on a patient who qualifies for routine foot care. This would be in addition to G0246!
Q Modifiers: Indicating Risk and Qualifying Conditions
Q modifiers are appended to the G codes to provide further information about the patient’s condition and risk factors.
- Q7: One Class A finding. For example, non-traumatic amputation of a digit or the foot.
- Q8: Two Class B findings. Examples include absent posterior tibial pulse, absent dorsalis pedis pulse, advanced trophic changes.
- Q9: One Class B and two Class C findings. Examples of class C findings include edema, burning, or temperature changes.
Class A, B, and C Findings These are specific clinical findings documented during the patient exam and are used, along with Q modifiers, to support the medical necessity of routine foot care for diabetic patients under Medicare guidelines.
- Class A Findings: Nontraumatic amputation of the foot or integral skeletal portion thereof
- Class B Findings:
- Absent posterior tibial pulse
- Advanced trophic changes, such as:
- Hair growth (decreased or absent)
- Nail changes (thickening)
- Pigmentary changes (discoloration)
- Skin texture (thin, shiny)
- Skin color (rubor or redness)
- Class C Findings:
- Edema
- Burning
- Temperature changes (e.g., cold feet)
- Paresthesia (abnormal spontaneous sensations in the feet)
- Numbness
Documentation: The Foundation of Successful Billing
Meticulous documentation is crucial. Your notes should clearly demonstrate the medical necessity of routine foot care and support the use of the chosen G code and Q modifier.
Document the following:
- Qualifying Systemic Condition: Clearly state the patient’s diagnosis (e.g., diabetes mellitus with peripheral neuropathy).
- Class Findings: Document the specific Class A, B, or C findings observed during the exam.
- Loss of Protective Sensation (LOPS): Results of monofilament testing.
- Vascular Status: Presence or absence of pulses, trophic changes, etc.
- Date of the last routine foot care visit.
It’s easy for errors to pop up, but it’s also fairly straightforward to seek help and prevent problems. If any of the information above raises further questions or you’re unsure of how to use it, be sure to give us a call.
We can help you avoid billing errors. A Step Above Health Management provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save you money and help streamline your billing process.
When it comes to podiatry billing, even seemingly small details can have a significant impact on your revenue, and that’s particularly true when it comes to the correct use of Modifier 25.
Are you leaving money on the table by misusing it or, even worse, being afraid to use it at all for fear of triggering audits? In this blog post, A Step Above Health Management will clarify when and how to use Modifier 25 and demonstrate how outsourcing your billing can help you maximize reimbursements and reduce denials.
What is Modifier 25?
Modifier 25 is appended to an Evaluation and Management (E/M) CPT code to indicate that a significant, separately identifiable E/M service was performed on the same day as a procedure.
Essentially, it tells the insurance payer, “Hey, I did more than just the procedure today; I performed a separate, billable E/M service, too!”
When to Use Modifier 25 in Podiatry
Here’s the tricky part: The E/M service must be truly separate and significant.
Here are some examples of when it is and is not appropriate:
- Appropriate:
- A patient presents for routine diabetic foot care (e.g., nail debridement or callous care) but also complains of new or worsening heel pain. You perform a separate evaluation to diagnose the heel pain. The E/M visit would get a -25 modifier.
- Patient presents for follow-up of an ulcer debridement. During the visit, they complain of new numbness and tingling in the other foot. The follow-up visit would be billed with a -25 modifier.
- NOT Appropriate:
- Patient presents for routine diabetic foot care. No new complaints. This does not get a -25 modifier.
- Patient presents for an injection. The doctor performs the injection and does a brief exam. This would also not get a -25 modifier.
Documentation is Key!
Your documentation must clearly support the medical necessity of a separate E/M service.
Think of it this way: Could another provider, looking at your notes, easily identify the distinct E/M service you performed in addition to the procedure?
Here’s what your documentation should reflect:
- A detailed description of the separate E/M service, including history, exam, and medical decision-making related to the new problem or a significant worsening of a pre-existing problem.
- Clear separation between the documentation for the procedure and the E/M service.
- A distinct diagnosis that is separate from the condition for which the procedure was performed.
The Outsourced Billing Advantage
Navigating the nuances of Modifier 25 can be challenging. This is where an outsourced podiatry billing and coding firm like ours can be invaluable.
Benefits of Outsourcing:
- Expertise: Our certified coders are experts in podiatry billing and stay up-to-date on the latest coding guidelines.
- Accuracy: We ensure accurate coding and modifier usage, maximizing your reimbursements and reducing denials.
- Compliance: We help you maintain compliance with complex billing regulations, minimizing your audit risk.
- Increased Revenue: By optimizing your billing processes, we help you capture all the revenue you’ve earned.
Modifier 25, when used correctly, can significantly impact your practice’s bottom line. However, improper use can lead to denials and audits. To prevent those from slowing you down and learn more about Modifier 25, please feel free to get in touch. We’d be happy to assist!
We can help you avoid billing errors. A Step Above Health Management provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save you money and help streamline your billing process.
Medically necessary treatment for foot, ankle or lower leg conditions such as injury or disease is covered by Medicare if provided by a podiatrist or physician. Generally, routine foot care that is not medically necessary will not be covered.
However, there are wide variations on exactly what is covered. Local Coverage Determination (LCD) policy, as determined by a Medicare Administrative Contractor (MAC), will decide whether a particular service is reasonable and necessary. LCD guidelines are developed in the absence of a national coverage determination or when the specific region feels that there is a need for further definition.
Insurance carriers may also have specific coverage determination policies in place.
Medicare Podiatry Billing – Adhere to LCD Codes
Your regional LCD will catalog which diagnostic ICD-10 codes may be paid for a specific CPT code. However, there cannot be an ICD-10 code for every possible situation.
Sometimes the ICD-10 codes overlap; in this scenario, when billing you must choose between two codes that are similar. However, the LCD may contain only one of the two so you must be able to make the right choice. One tool that may help is when you receive a Medicare explanation of benefits (EOMB). There may be a reference to an LCD that may have been updated.
The LCD has other information that is essential for accurate claims billing. For example, the LCD may indicate:
· How often routine foot care is allowed
· The frequency that a service is allowed in a certain time period
· Which additional ICD-10 codes are required as secondary codes
· Which products are appropriate for certain types of wounds and if conservative care is first required
LCD billing information helps you to get paid for your services because bills are properly coded. It is in your practice’s best interest to use billing information that is as accurate as possible and, when errors occur and are noted, to update your process for future similar scenarios.
More Resources
CMS MLN Matters describing Medicare Podiatry Services
CMS list of MAC jurisdictions
Let Us Manage All Your Podiatry Medical Billing
A Step Above Health Management Systems provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to handle all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save you money and help streamline your billing process.
While many podiatric treatments and services are covered by insurance, there are instances where out-of-pocket expenses may be necessary. For your patients and your practice, increased clarity makes all the difference, so it’s important to lay out what is and isn’t covered in the clearest terms possible.
For this blog post, the team at A Step Above Health Management will help you do just that. Keep reading to delve into some common podiatric conditions that often require insurance claims, then see which services may not be covered.
Common Podiatric Conditions Requiring Insurance Claims
- Diabetic foot ulcers: Serious complications of diabetes, often covered by insurance due to their association with a chronic condition.
- Bunions: Bony bumps at the base of the big toe, which can be covered by insurance if they cause significant pain or disability.
- Hammertoes: Deformities of the toes, often covered by insurance if they lead to pain or functional limitations.
- Neuropathy: Nerve damage in the feet, often covered by insurance if associated with underlying medical conditions like diabetes.
Non-Covered Podiatric Services
While many podiatric services are covered by insurance, some may require out-of-pocket payments. These may include:
- Cosmetic procedures: Procedures aimed at improving the appearance of the feet, such as toenail reconstruction or wart removal.
- Orthotics: Custom-made shoe inserts, which can be expensive and may not be fully covered by insurance.
- Diabetic Shoes: A frequent source of frustration for podiatrists and patients alike is the fact that diabetic shoe coverage can be difficult to attain. Take extra care to avoid common mistakes, ESPECIALLY when dealing with Medicare.
- Routine foot exams: Preventive care, such as regular check-ups for healthy feet, may not be fully covered by insurance. This is of particular concern when dealing with patients who suffer from diabetes, in which case there are some ways to find exceptions to the rules.
Understanding Your Insurance Coverage
It’s essential for patients to review their insurance policies carefully to understand what is covered and what is not. Instruct them to contact their insurance providers to clarify any questions regarding coverage for podiatric services. After all, accurate billing means more patient satisfaction and less time diverted from your main goal: delivering the best podiatric services possible.
We can help you avoid billing errors. A Step Above Health Management provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save you money and help streamline your billing process.
Podiatrists are experts in resolving foot and ankle complications, but managing the financial side of their practices can be difficult without the right tools or team to do so. For podiatrists, billing involves complexities that are specific to foot and ankle care, and some unique challenges result from that fact.
A Step Above Health Management Systems has been at the forefront of simplifying podiatric billing for some time now, so we’ve gathered plenty of helpful info along the way. For this post, we’re going to draw on that data and provide you with some of the most common obstacles we see DPMs facing these days, plus a few helpful hints for managing each one.
The Coding Maze
- Accurate documentation and submitting insurance claims are only part of the puzzle.
- Podiatry billing relies on specific coding systems (CPT and ICD) that are constantly revised.
- Using the wrong codes leads to claim denials, reimbursement delays, and financial harm.
Stay Updated and Get Automated
- Consistent training that keeps staff abreast of the latest coding updates is vital.
- Software featuring automated code updates can minimize non-compliance errors.
Insurance Verification and Pre-Authorization Hurdles
- Confirming patient insurance coverage and acquiring pre-authorization for procedures is often time-consuming and complex.
- When it’s not handled efficiently, costly delays are sure to follow.
Boost Efficiency and Use Tech
- Automated verification systems rapidly confirm insurance details and pre-authorization needs.
- This reduces delays and inefficiency for your practice and enhances the patient’s experience.
Accurate Documentation and Complete Compliance
- Incomplete or inconsistent documentation could result in claim denials and compliance headaches.
- In the current regulatory environment, sticking closely to healthcare guidelines is crucial to avoiding significant penalties.
Standardize and Automate
- Standardized practices for record-keeping and podiatry-specific Electronic Health Records (EHR) systems will improve documentation accuracy.
- Standardization also accelerates smooth incorporation with existing billing processes.
- Consistent internal audits can detect and resolve documentation gaps, confirming compliance with industry standards.
Costs and Communication
- Poor communication concerning financial responsibility might cause confusion or even lead to billing disputes.
- Patients might not be aware of all the information pertinent to their insurance coverage or potential out-of-pocket costs.
- Unsatisfied patients upset about discrepancies or disputes can damage your practice’s reputation.
Solution: Prioritize Transparency
- Honest, clear conversations with patients are essential.
- They must be made aware of financial obligations in a prompt and professional manner.
- Offering upfront assessments of estimated costs and providing flexible payment options increases patient satisfaction and streamlines the billing process simultaneously.
Podiatry practices have plenty to do without worrying about billing complications and insurance-related issues. We hope the blog above helps you focus on the patient outcomes that matter most!
We can help you avoid billing errors. A Step Above Health Management Systems provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save you money and help streamline your billing process.
Surveys regarding patient satisfaction with their medical practice show some surprising results. The majority of patients rate their doctors quite highly. In fact, in one such study only 4% of the complaints were regarding medical treatment; 96% were about administrative and organizational issues. The biggest complaints, it turns out, stem from the billing office and waiting room—not the exam room.
Today, poor reviews from patients have a much wider reach than previously. Online reviews of medical practices are the way that many people express their satisfaction or dissatisfaction. Another interesting finding is that those patients who are dissatisfied tend to write much longer and more detailed reviews than patients who had a positive experience. For your practice this means one negative review can translate into a significant impact on your bottom line as people searching online for a podiatrist will be more likely to pass over your practice if lengthy scathing reviews are on your site.
What Makes Patients Dissatisfied?
The issues that drew the most negative responses were connected to communication and billing. Many patients are subject to collection agency calls and other tactics for medical bills that they either have no idea what they are for or that they claim they have already paid.
According to the Consumer Financial Protection Bureau chief complaints included:
- Inaccurate medical bills
- Bills for services they did not receive.
- Difficulty reaching a billing specialist and getting explanation of a bill.
- Not receiving a bill before hearing from a collection agency
- Debt collectors including detailed medical information in attempts to collect on a claim which violated privacy policies.
- Being informed that their credit score had gone down due to an unpaid medical bill.
Accurate, timely, and efficient billing services which allow patients direct access to a billing specialist when there’s a question or problem are a must for today’s podiatric practices. To be deficient in this key area of your practice can result in the loss of current patients and a lack of referrals and new patients.
We can help you avoid billing errors. A Step Above Health Management Systems provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save your money and help streamline your billing process.
As a podiatrist, you’re dedicated to providing your patients with the most excellent and compassionate care possible. You’re doing your best to run an efficient office that maximizes the time and talents of your team. The time-consuming job of billing to get the appropriate compensation for services throws a monkey wrench into the works for many podiatric practices. Below are some tips for overcoming common billing challenges and generating more revenue with less hassle.
Be in the Know
One thing is certain about billing codes for podiatric medicine—they are constantly changing! It’s important that you allocate resources of staff and time to stay current on codes and other updates. Incorrect coding can slow your revenue collection significantly and cost additional work hours. Frequent mistakes can be a red flag for an audit and, even worse, open you up to allegations of fraudulent billing.
Don’t Leave Money on the Table
Submitting clean claims is just the first step to better billing. Often claims will be denied or rejections. These require prompt follow within prescribed time limits. Missing those deadlines can mean forfeiting money that legitimately belongs to your practice.
Establish Friendly but Firm Collection Policies
Most patients will still have a co-pay due for the services you provide. Studies show that it’s very difficult to collect co-pays once a patient has left the office. In fact, when you factor in staff time, materials and postage it makes it almost not worth it to try. The sum total of these monies is not insignificant, however. Train staff on how to politely but firmly insist that co-pays be paid at the time of service. Many offices ask for payment at check-in rather than check-out to help smooth the process and increase compliance.
Good billing practices keeps patients happy too. Getting multiple bills for the same service or being told your patient responsibility is more than expected due to incorrect claim filing creates headaches and bad feelings with patients that may lead to a loss of repeat business and referrals.
We can help you avoid billing errors. A Step Above Health Management Systems provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save your money and help streamline your billing process.
Today more than ever, medical practices are trying to cope with increasing costs while keeping the revenue stream steady or, better yet, increasing. How can you thrive in tough economic times?
Here are some tips to help your practice flourish:
- Strive for excellent customer service—a patient called to get a copy of a bill for a particular service they needed to submit for insurance. A friendly staff member answered the phone the first time the patient called and assured them they would email the copy of the bill within the hour—and then they did it. This patient was so stunned at this high level of customer service in an age where every service-related matter takes days or weeks to resolve that they kept relaying the story to their friends. When these friends needed a podiatrist, whom do you think they called? Personal contact and good service can bring in new patients and help you keep the ones you have.
- Stay current on treatments and technologies—minimally invasive surgery, laser treatment for toenail fungus, extracorporeal shockwave therapy, and other new, cutting-edge technologies are sought after by today’s podiatric patients. Of course, you have to balance the cost of equipment and training with your office demographics, but when patients hear about new treatments for foot ailments, they will seek a podiatrist who offers them.
- Improve efficiency for higher patient volume—seeing more patients translates into more billable services. However, this strategy will backfire if you overbook, resulting in long wait times. The key is to improve the flow and efficiency of a patient visit in your practice. Increased efficiency in your office will enable you to see more patients without compromising on care.
- Invest in your billing staff or go pro—podiatric billing is complicated, and rules and codes change frequently. Many practices lose revenue because they do not file clean claims, to begin with, and they don’t have the staff to pursue rejected or denied claims. This results in a good deal of money being left on the table. Designate specific staff for billing and give them the training they need or consider moving your billing to a professional service.
We can help you avoid billing errors. A Step Above Health Management Systems provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save you money and help streamline your billing process.
It’s a new year and a good time to take a look at what’s happening in the field of podiatry and how those changes may impact your practice and your bottom line. Below are some trends for 2023:
Staff Shortages—In the “Great Resignation” many employees have decided to leave healthcare positions in exchange for lower-stress jobs. In fact, 58% of medical practices anticipate that staffing will be their biggest challenge in 2023. Decreases in physicians, assistants, and podiatry students are all contributing to this shortage. This means taking good care of your team members will be essential. Avoiding overburdening staff and utilizing technology to decrease the clerical and billing workload will be essential.
Need for Increased Patient Engagement—Medical practices are still seeing Covid fallout in terms of patient behaviors. Many patients decreased their podiatric office visits during Covid and searched for at-home alternatives or sought podiatric care through other types of practitioners. Maintaining good patient relations is more important than ever. Studies show that patients want the ability to make appointments and pay their medical bills online. Making sure that the technologies and services you use for these are user-friendly and run smoothly will increase patient loyalty.
Declining Reimbursements—A recent survey by Podiatry Management showed that podiatrists are collecting on average 56% of their listed fees. Medicare, Medicaid, and private health insurers do not cover routine foot and ankle care to the same level as a primary-care physician visit. Podiatrists are becoming more dependent on patients’ out-of-pocket expenditures. Offering specialized services and above-average customer service will be critical in maintaining a healthy bottom line.
We wish you a happy New Year and hope it will be a profitable one for your practice!
We can help you avoid billing errors. A Step Above Health Management Systems provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save you money and help streamline your billing process.
