As it is currently with nearly all medical specialties, getting paid flawlessly is a challenge in podiatry. Newly-introduced podiatry coding guidelines, combined with an increasing number of patients, make it harder for physicians to receive fair payments for their services.
Podiatry medical billing is a distinctive craft that brings a lot of challenges and pitfalls. According to a research we have performed for one of our prospective clients, mistakes in insurance claims billing and payment collection may lead to up to 27% revenue loss for podiatry providers. While it may be hard to convince unscrupulous insurance carriers or patients to pay diligently, you can still prevent a large portion of underpayments on your own. In this article, we are going to cover the most popular challenges of podiatry medical billing that you can tackle without too much of a hassle.
I. “Unclean” claims
Out of the above-mentioned 27%, 20% of revenue loss is caused by mistakes and inconsistencies in medical coding. Billing guidelines are updated regularly, and it is quite a challenge to keep up with them. There are hundreds of instances where a certain diagnosis or procedure cannot be billed with other codes unless a modifier is indicated on a claim, or when it cannot be appended as primary (first in a row) on a claim. Even a single incorrectly applied code may lead to an entire claim denial or rejection. For example, CPT 11056 (Paring or cutting of benign hyperkeratotic lesion) cannot be reported with 11305 (shaving of epidermal or dermal lesion) because these codes are mutually exclusive. However, most unclean claims are caused by trivial typos in codes and patients’ demographics. Taking the following actions will help you deal with this challenge:
• Check Medicare National Correct Coding Initiative (NCCI) database before submitting a claim to ensure that there are no mutually exclusive codes.
• Verify your patients’ eligibility upfront and from a credible source. We recommend that you encourage your new patients to bring their insurance ID cards to an appointment. This way, your staff will be able to get the correct demographics straight away.
• Double-check your claims before submission. It is recommended to perform an internal validation procedure prior to submission to identify and correct mistakes.
II. Prompt responses to requests from insurance payers
Due to their specificity, podiatry services often require a proof of medical necessity. Requests for such information from insurance payers are always time-sensitive. A significant portion of podiatry claims gets underpaid because providers simply fail to submit the charts on time. We encourage you to regularly check your mailbox for such requests, and send the requested information as quickly as possible once you get a letter from the carrier. Electronic submission is preferrable in such situations.
III. Swift work on denials and rejections
Like with all other specialties, underpaid podiatry claims require to be worked upon quickly and efficiently. We recommend that you monitor your claim denials once a day, and instantly resolve them. This is especially important for rejected claims, for those need to be resubmitted within a payer’s timely filing limit. Besides, many insurance carriers have a timely filing limit for reconsideration requests and appeals. Missing any deadline may cost you thousands of dollars.
IV. Being up to date with the current payment policies
The CMS and commercial insurances tighten up their payment regulations. Many benefit plans no longer offer coverage for podiatry services, both in-network and out-of-network. In addition, new reimbursement rules limit the frequency and circumstances under which services are covered. Non-compliance with such ever-changing rules leads to surprise denials and costly recoupments. There is one way to protect yourself against them – by singing up for WCH Insights, our monthly digital magazine where we publish and explain the most significant payment policy updates for a variety of insurance carriers.
V. Effective patient payment collection and customer service strategy
Out-of-pocket costs paid by patients may constitute a large portion of your revenue flow. Some patients may delay or appeal their dues for no tangible reason. In these circumstances, you should follow credible revenue identification and collecting practices. Your staff should be aware and present-minded when it comes to sending bills and making follow-ups. An incorrectly submitted medical bill (for example, the one submitted to a Medicaid patient), may cause a misunderstanding at its best and a formal complaint at its worst. You should designate one particular day of the week as the day of patient payment collection, when your staff would carefully analyze who to bill, and who to contact for a follow-up.
Podiatrists face so many challenges when it comes to getting paid for their services. However, each of them has a solution. At WCH Service Bureau, we care about the prosperity of your practice. While we do not handle patient payment collection, our experts can help you with all other challenges of podiatry reimbursement.
Interested? Contact us!