Prepare to elevate your expertise to new heights at the highly anticipated 13th Annual Valley of the Sun Conference! As leaders in foot and ankle health, you recognize the profound impact your work has on enhancing the lives of your patients, ensuring they stride with comfort and confidence.
Hosted by the renowned non-profit educational foundation, The Podiatry Institute, this year’s conference promises an unparalleled opportunity to learn about the latest advancements and best practices in podiatric medicine at the picturesque Marriott Phoenix Tempe at the Buttes in Phoenix, AZ.
To empower you further, we’ve curated a special segment dedicated to demystifying the complexities of podiatry medical billing. Discover new insights and knowledge at the Valley of the Sun Conference this April 18–21, 2024!
Conference Overview
The 13th annual event, presented in collaboration with the Arizona Foot and Ankle Medical Association, offers up to 25 continuing education contact hours. You have a wide variety of podiatric care topics to choose from, including:
- Medicine infection updates
- Dermatology
- Innovative treatments in podiatric medicine and surgery
- Hallux valgus, forefoot, rearfoot, and ankle care
- Wound care and diabetes management
- Infection management and reconstruction
- Pain management
By attending this year’s Sun Conference 2024, you can gain practical tools and knowledge to address various foot and ankle conditions effectively. Specifically, you will:
- Explore various surgical options for hammertoe repair and understand the associated risks and long-term complications.
- Become familiar with different surgical procedures for managing hallux valgus and associated deformities.
- Learn about current treatment options and advanced therapies for diabetic foot care.
- Discuss goals and expected outcomes in managing heel and hindfoot conditions, including soft tissue management, fractures, and failed tendon surgeries.
- Expand your understanding of different products, diagnosis of carcinoma, mechanisms of ankle fractures, and less common anatomical variants and procedures.
Don’t miss the Valley of the Sun Conference in podiatric medicine and surgery. Register now to enhance your expertise and network with peers!
For more information and registration details, visit The Podiatry Institute.
Impact of Improved Billing in Podiatric Practices
Besides diagnosis or clinical processes, enhancing podiatry billing and financial management practices is crucial. This ensures that patients continue receiving high-quality foot and ankle care while the clinic remains financially sustainable.
Here are the main points that explain the importance of improving billing practices in podiatry:
- Improved Patient Care: Enhancing podiatric practices involves streamlining processes, which can lead to more efficient patient care. By optimizing billing practices, clinics can allocate more time and resources to patient treatment and education.
- Financial Stability: Efficient billing practices are essential for maintaining the financial stability of podiatric clinics. Timely and accurate billing ensures that clinics receive proper reimbursement for services rendered, reducing revenue loss and improving cash flow.
- Compliance and Documentation: Podiatric procedures and services often involve specificities that require accurate documentation and coding for billing purposes. Utilizing customized billing platforms for accurate documentation not only ensures compliance with regulatory requirements but also supports precise billing and payment.
By improving billing procedures, you can focus more on providing outstanding care to your patients without worrying about your practice’s financial risks.
Understanding Podiatric Billing Challenges
Collaborating with outsourced podiatric medical billing services helps podiatrists overcome the complexities of billing. Here are the top three challenges faced by podiatrists when it comes to billing:
Specificities of Podiatric Procedures and Services
Podiatric procedures and services vary significantly, presenting challenges in documenting and coding services for billing purposes. Podiatrists must provide the specifics of each procedure to support proper coding and billing.
Coding Complexity and Specificity Requirements
Podiatrists must use specific codes such as Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) to record their services accurately. This process is complex as it requires a high level of specificity, which is vital for reimbursement and compliance.
Reimbursement Delays and Denials
Medical billing for podiatry faces delays or denials due to various factors, including:
- Coding errors and documentation requirements
- Insurance companies with specific rules or limitations for podiatric services
- Different reimbursement rates and fee schedules across payers
Podiatry clinics benefit from partnering with experienced medical billing professionals to manage these billing challenges efficiently. 5 Star Billing, with many years of experience in podiatry billing, has successfully reduced claims adjustment rates to as low as 12% with Medicare. This is significantly lower than the standard rates of 20% to 35%. As a result, clinics can enjoy a higher average return per processed claim.
Unlocking Success in Podiatric Billing
Join us for an in-person Q&A session, as we dive into the intricacies of podiatric billing and offer valuable insights to propel your practice forward.
Get Expert Guidance on Regulatory Compliance
Managing podiatric billing can be challenging, especially with ever-changing coding and billing regulations. At our booth, we’ll discuss how we can:
- Ensure your clinic stays compliant with the latest regulations
- Interpret complex billing requirements
- Provide aid with coding guidelines
Ensure Seamless Transition to New Billing Solutions
Our medical billing experts provide training sessions and adequate support to ensure a smooth transition for your staff members. We offer software implementation and customized training sessions to equip your team with the knowledge and tools they need to excel in the billing and reimbursement process.
Streamline Billing with Leading EHR Integration
Discover the power of integrated billing solutions at our booth. Our team can guide you through the software implementation process with your preferred systems, such as 1st Providers Choice.
Maximize Return on Investment
Through thorough analyses and projections, we can help you make informed decisions that optimize the return on your investment (ROI) in billing solutions and strategies, ensuring profitability for your practice.
Tap Into Our Expertise
Are you ready to revolutionize your podiatric practice’s billing process? Visit our booth and discover the podiatry billing services that have transformed the specialty through end-to-end billing management!
As an Arizona-based corporation, 5 Star Billing offers top-tier medical billing services nationwide. Our in-depth knowledge of the latest podiatric coding standards guarantees a high first-pass rate and accuracy in your billing processes.
Experience the power of our customized services, even if you can’t attend the conference! Take advantage of this opportunity to optimize your podiatric billing experience by scheduling a free appointment with 5 Star Billing.
Podiatry coding and billing are challenging because treatments and procedures involving the foot are unique due to medical necessity requirements and restrictions on certain conditions. To get the most out of your reimbursement, you need to have complete documentation. Also, you need to know insurance coverage and complicated codes. Here are five tips for boosting your reimbursement:
Appeal for denials
When the insurer has decided not to cover a claim, a claim may be denied, and it will not be paid. Check the explanation of benefits (EOB) sent by the health insurance company to know the exact reason for denial before appealing. Address the reason for denial when appealing. Check the carrier’s written policy for exceptions, as well. Following the submission of the appeal, the practice staff can either contact the insurance provider to confirm receipt of the appeal, or check the submission online and follow up within 30 days. Following appeal submission, the practice staff can either contact the insurance provider to confirm receipt of the appeal or check it online and follow up in 30 days.
Verify insurance properly
The method of reviewing the patient’s plan with the insurance provider and confirming the eligibility of his or her insurance claims is known as health insurance verification. In podiatry billing, the first step is to verify insurance coverage. Until beginning care, check and validate the patient’s insurance eligibility and benefits to minimize denials and improve cash flow. Patients must be aware of their payment obligations at the time of appointment scheduling, which aids in their decision-making and helps the practice prevent last-minute cancellations due to ineligibility.
Verify all information, including the patient’s name, date of birth, address, insurance ID number, deductible, and insurance phone number, in addition to confirming the patient’s insurance coverage.
3. Claims Involving Complicating Conditions
On the first submission of a claim for podiatry claims involving complicated conditions, coders must document the name of the physician who diagnosed the condition and the approximate date the beneficiary was last seen by the indicated physician (when active care is required). Carefully record the diagnosis and the severity of the diagnosis.
4. Accurate codes matter
Coding in the field of podiatry is quite complex. In medical claims, you need to use the most suitable code to record podiatry procedures. It is vital to use the correct CPT, HCPCS, and ICD-10 codes for all medical statements, whether you link it to pressure ulcers, illnesses, fractures, active wound care management, or debridement.
Use the following medical codes in billing for foot care:
CPT:
- 11055 – Skin lesion Trimming
- 11056 – Skin lesion Trimming (two to four)
- 11057 – Skin lesion Trimming (more than four)
- 11719 – Non-dystrophic nails trim
- 11720 – Nail Debridement (till 5)
- 11721 – Debridement (more than six)
- 11730 – Partial or complete nail plate avulsion
- 11732 – Additional partial or complete nail plate avulsion
HCPCS:
- G0127 – Dystrophic nails trimming, any number
- G0245 – Initial physician assessment and treatment of a diabetic patient with diabetic sensory neuropathy resulting in lops, which may include: (1) a lops diagnosis, (2) a patient history, and (3) a physical examination that includes at least the following components: (a) visual examination of the forefoot, hindfoot, and toe web spaces; (b) assessment of a protective sensation; (c) assessment of foot structure and biomechanics; (d) assessment of vascular status and skin integrity; and (e) assessment and footwear recommendation; and (4) patient education
ICD-10:
- B35.3 – Tineapedis
- B07.0 – Plantar wart
- E11.621 – Type 2 diabetes mellitus with foot ulcer
- E13.4 – Other specified diabetes mellitus with neurological complications
- S83.9 – Sprain of unspecified site of knee
- S93.3 – Subluxation and dislocation of the foot
Coders must keep up with changing coding standards and guidelines, as any mistakes in codes submitted will result in claim rejection or payment delays.
5. Choose the right modifier.
It would be necessary to apply appropriate modifiers to a claim form that contains such procedure codes to distinguish between the codes that were paid on the date of operation. Class A (Q7), Class B (Q8), and Class C (Q9) results are denoted by “Q” Modifiers (Q7, Q8, and Q9) in podiatry.
The following are some of the most common modifiers used in podiatry billing:
- GX Notice of liability issued, voluntary under payer policy
- GZ Item or service expected to be denied as not reasonable and necessary
- Q7 One Class A finding
- Q8 Two Class B findings
- Q9 One class B and 2 class C findings
You can modify the procedure codes 11055, 11056, 11057, 11719, 11720, 11721, and G0127 with the “Q” modifier. When submitting claims with the Q7, Q8, or Q9 modifiers, indicate the findings related to the patient’s condition.
- Class A Findings: Non-traumatic amputation of the foot or integral skeletal portion thereof.
- Class B Findings: Absent posterior tibial pulse, advanced trophic changes, and absent dorsalis pedis pulse.
- Class C Findings: Claudication, temperature changes, edema, paresthesias, and burning.
The use of correct modifiers often aids in the collections, reducing errors, and avoiding revenue decline. When hiring an outsourced podiatry billing company to handle such paperwork, make sure they specialize in podiatry and experts in the medical billing industry.
Tap Into Our Expertise
At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing. Save your money by outsourcing to a professional billing service.
Schedule a call with our experts today!
Podiatry billing is said to be more challenging than other specialties. It involves different procedures making it more intricate as it requires meticulous coding related to where, when, and what procedures were made. It needs the most competent billers and coders who are up-to-date with the latest revisions of the requirements for Podiatry billing, code-specific regulations, and compliance standards. Even the smallest mistake or error could lead to denials of claims and loss of revenue. Here are the best practices and tips for Podiatry billing straight from our medical billing and coding experts:
Podiatry Billing Tips and Practices
1. Update your Billing System and Software
It is important to utilize the correct billing system that suits your practice to keep up with today’s dynamic and rapidly changing market. It will help improve the efficiency, quality, and turnaround time by investing and implementing an acceptable EMR, billing system, and software.
2. Include Comorbidities in Coding
Providers documents relevant conditions called comorbidities. Coding them will help you receive higher reimbursements. It also notifies the insurer about the additional cost.
3. Code Diagnosis Instead of Symptoms
Unless there are client-specific guidelines to code the symptoms, it is essential to analyze the medical reports and code the confirmed diagnosis instead of reporting symptoms. Similarly, the coding of additional disease-related symptoms should be avoided unless indicated.
4. Stay Current with the Billing and Coding Changes
The first step towards effective Podiatry billing is to guarantee that your team is up-to-date with the latest changes to the billing and coding guidelines. The guidelines for Podiatry-related procedures and medical billing are often updated and modified due to their complexity. It is essential that your Podiatry billing team stays current.
5. Audit your Medical billing and Coding Regularly
Podiatry coding and billing mistakes can appear unavoidable due to their complex nature. Having regular audits can help monitor the percentage of errors while at the same time helping to analyze their causes. It ensures consistent steps are taken to minimize recurring errors. The audit also helps you to consider the staff and provide them with extra preparation or retraining. ‘
6. Reevaluate Your Documentation Process
Podiatry billing can be challenging. Any documentation gap can result in missed billable codes, which would potentially hamper the practice revenue. Accurate and full documentation of the exact process is necessary to minimize the rejection of claims. Processing claims with insufficient and erroneous paperwork can be time-consuming and lead to delays in services.
7. Use Combo Codes Appropriately
Podiatry coders must be careful to follow different coding guidelines, such as “Code also,” “Use additional codes,” “Code first,” etc. When necessary, it is important to use combo codes to prevent claims that are rejected, delayed, and denied. However, lacking combo codes implicitly means missing the bill.
8. Outsource your Billing and Coding
You can always partner with a trusted name in medical billing and coding like us at 5 Star Billing Services. We focus solely on medical billing and coding so you can focus more on your clinical services. It will help reduce your turnaround time, overhead cost, and hiring and staffing. Our staff is regularly trained to increase your productivity and quality service.
Tap Into Our Expertise
At 5 Star Billing Services Inc, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times.
Schedule a consultation with our experts today!
