Your podiatry practice provides an invaluable service to patients with foot conditions, but unfortunately, not all insurance companies see it that way. Many insurance companies deny claims from podiatrists because they don’t think your services are a medical necessity. Not only do those podiatry medical billing denials cut into your revenue, but dealing with them also takes time that your busy practice likely doesn’t have.
To make sure that insurance companies pay claims for podiatry services, you’ll have to code those services the right way. Here’s everything you need to know about best practices for medical billing.
The Importance of Accurate, Timely Podiatry Billing
Why is accurate and timely medical billing so important? Without it, your medical billing service could submit the wrong codes to insurance companies. For instance, podiatry billing services may (accidentally or purposefully) submit codes for the wrong medical diagnosis or condition.
Inaccurate podiatry billing can lead to underpayment, which can slash your revenue. You could also get into trouble for not complying with private payer policies or government regulations.
Proper coding is critical because it ensures accurate reimbursement. It also helps improve patient care, safety, and outcomes. Advisory boards and credentialing services use these codes to evaluate the performance of healthcare professionals and identify problems with the quality of foot care.
Best Practices for Podiatry Medical Billing
Medical billing can be complicated, but by following these best practices for coding, you can cut down on claim denials and ensure that insurance companies properly reimburse you for the care services you perform.
Keeping accurate documentation is key for proper medical billing and practice management. Insurance companies commonly deny claims for mistakes that podiatry billing specialists make with:
- Podiatrist information
- Patient information (such as names, birthdates, and insurance ID numbers)
- Missing or inaccurate codes
To make sure that you code services correctly, use an updated medical billing system, such as ChartLogic EHR. Outdated medical billing systems may use old podiatry coding that could result in denied claims. If you’re outsourcing podiatry billing, your podiatric billing service should keep up with all changes to ICD and CPT codes, too.
Your medical billing company should also perform eligibility verification to confirm copayments, deductibles, and coverage with a patient’s insurance company.
To ensure reimbursement of claims, your family practice billing system or physical therapy billing system must submit those claims with the proper codes. Some claims denials are simply the result of a mistake with medical billing software, while others are due to fraudulent coding by medical billing services.
For instance, a medical biller may give a code for a service that the provider didn’t perform or enter a code for a service that’s pricier than the one the patient received (called upcoding). Some podiatry medical billers do this in an attempt to get the clinic revenue for work it didn’t do.
Undercoding is another fraudulent practice to watch out for. A podiatry billing service may code for a less-serious procedure to try and save patients money.
Both practices spell trouble for your clinic. Undercoding and upcoding constitute fraud and could subject your medical practice to an audit. You may also be held liable for submitting claims to Medicare for services not provided.
To improve accuracy and minimize claim denials, professional coders should use the right modifier with their coding services. For example, Covered Nail Debridement (CPT Code 11721) requires the Q8 modifier (for routine checkups).
Timely Submission of Claims
All insurance companies have a timely filing limit for the submission of claims. Blue Cross Blue Shield (BCBS), for example, has a filing limit of 95 days in Texas and 180 days in Minnesota. If you don’t submit claims to the insurer by the deadline, it will deny them.
Even worse, denials for missing the timely filing limit are final, which means you can’t appeal them. The insurer will not reimburse you, leaving you on the hook for those costs.
You may think that you would never submit a claim past the deadline, but as a busy healthcare provider, it’s not uncommon for such tasks to fall through the cracks. This is why it’s so important to stay on top of podiatry medical billing services.
Timely filing limits vary widely by insurance company. You can find filing limits in the provider manual for each insurer.
Denied claims or unpaid patient bills can affect your revenue without a plan to follow up and secure payment.
Ideally, you should have an accounts receivable (A/R) follow-up team who follows a billing process, handles denied claims, and reopens them with insurance companies. Follow-up for medical billing services has three stages:
- Initial evaluation: The A/R team reviews the provider’s policy and identifies claims that need to be adjusted.
- Analysis: The team marks claims that the insurance company hasn’t paid according to its contracted rate.
- Collection: The team verifies billing information and confirmation to billing rules, then follows up for payment.
Compliance With Regulations
Medical coding fraud is a huge problem in the healthcare industry, which is why the government outlines laws and regulations to help combat it.
The U.S. Department of Justice could slap you with a fine for filing a false claim for Medicare or Medicaid services. If you commit a serious act of fraud, you might even lose your license to practice.
Types of fraud to avoid include:
- Upbundling: Submitting more than one bill for the same service
- Phantom billing: Billing for supplies or services a patient never received
- Double billing: Submitting multiple claims for the same service
The All-in-One Podiatry Billing Solution: Weave
Doing medical billing the right way can save a ton of time and prevent headaches and busy work for your podiatry practice staff. If you’re tired of dealing with the hassle of billing mistakes, late payments, and claim denials, try Weave! Our software makes it easy to stay on top of billing so you never miss a payment.
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Weave Payments is a full processing solution that empowers you to bill and collect more efficiently within Weave using patient-preferred payment methods.Schedule Demo