News

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.