Podiatry Billing Services

The financial stability of your Podiatry practice is intrinsically tied to the timeliness of billing and the effectiveness of account reimbursement. Our proficiency is grounded in years of experience providing Podiatry billing services.

Opting for a premier billing service is a critical decision for the business aspect of your practice. The complexity of Podiatry billing and modifiers necessitates a billing company with extensive experience. Choose 5 Star for unmatched financial security. We encourage you to get in touch for further information about our services, including client testimonials and detailed insights into our Podiatry billing expertise. Our committed team is dedicated to improving the efficiency and profitability of your practice through careful billing management and customized support designed to meet the specific requirements of Podiatry professionals.

A Few Of The Software Companies We Work With

1st Providers Choice Billing Services

ModMed Billing Services

TRAKnet Billing Services

Sammy Billing Services

We offer services for many EHR software companies, please contact us for more information

5 Star Billing Services has significant experience working with podiatry practices. Our billing service is designed to assist podiatrists in boosting their revenue collections, minimizing the occurrence of claim denials, and sustaining a robust accounts receivable status. By streamlining the billing process and ensuring accuracy in coding and submissions, we aim to enhance the financial performance of podiatry practices, enabling practitioners to focus more on patient care and less on administrative tasks.

In order to perform billing and coding tasks for podiatry practices and to receive maximum reimbursement for services provided, it is important to understand the complex rules and guidelines that insurance companies use to judge podiatry claims. Many billing services claim to have this industry insight, but often fall short. For example, medical billing companies that do not specialize in podiatry billing may not have the ability to properly track and pursue underpayments – and this could cost a podiatrist approximately 10 percent of their income. In order to avoid billing and coding-related pitfalls such as this one, podiatrists should work with podiatry billing services employing qualified, certified billers. To learn more about 5 Star Billing Services and out experience working with podiatry practices, contact us at 480-999-0180.

Benefits

Increased revenue and higher earnings
Quicker payment processing and reduced stress
24/7 access to patient information and financial data
Full transparency throughout the revenue cycle
Detailed financial and practice management reporting
Confidence in professional billing management for improved reimbursements and income growth

Comprehensive Podiatry Billing, Collections & Practice Management

5 Star provides extensive Podiatry billing services and collections.
An initial assessment of your practice and accounts receivable is included before progressing.
Our streamlined process makes it simple to get started, and we are dedicated to ensuring you get paid.
Our Certified Professional Coders ensure maximum reimbursement.
Specialized computer systems and software are designed specifically for podiatrists.
Our service includes patient data entry, statement generation, and follow-up.
Comprehensive electronic claims and accounts receivable management are integral to our services.

Our ability to handle practices with multiple physicians and locations, combined with our personalized attention, ensures your account receives the care it deserves.

Area of Expertise

Podiatry Billing and Collections
Proactive collection strategies with insurance companies
Ensuring maximum reimbursement for your services
Exceptional customer service for you and your patients
Effective communication and information exchange with 5 Star

Electronic Claims Submission

Certified Professional Coders on our team

Remote access to all your patient data

View patient balances and transaction history

Comprehensive end-of-month reports

Regular issuance of patient statements

Receivables Management

Coding
Billing
Relations with payers
Relations with patients
Collections
Client reporting
Fee analysis
Management of managed-care contracts

Speak with a Podiatry Billing Specialist today!

Our billing service helps pod iatrists increase collections, decrease claims denials, and maintain healthier accounts receivable.

Your Dedicated Podiatry Billing Partner

Specialized Podiatry Billing Services

A proficient Podiatry billing company is key to enhancing your reimbursements. Such a service should outperform your office in billing efficiency and effectiveness. It should enable you and your staff to concentrate on providing medical care, while also boosting your practice's profitability over in-house billing.

Industry specialists suggest that a claims adjustment rate of 20% to 35% is standard and acceptable. At 5 Star, our account executives boast an average of eight years in podiatry billing, ensuring lower adjustment rates, even as low as 12% with Medicare. This expertise means higher A/R rates for our practices compared to the industry norm, leading to a greater average return per processed claim.

5 Star Billing Services transcends traditional claims processing with comprehensive benefits and services. Our advanced billing system generates and accurately codes your claims daily, ensuring electronic submission for quick processing. With our system, payments can be received in as little as ten days.

Since 1983, the 5 Star Billing team has provided the Podiatry community with cutting-edge software solutions. As an Arizona-based corporation, we proudly offer both Server-Based and Web-Based Podiatry Software solutions, servicing our products from within the United States. Our experience positions us to guide Podiatry Practices towards a profitable, paperless future. Contact us at 480-782-1116 to modernize your practice.

Reducing Your Expenses with Specialized Billing

Our clients see a reduction in office expenses through our services and software. All that’s required is a PC with internet access. Our comprehensive practice management software, accessible online, is part of our standard offering without additional costs for updates or support.

Preferred Health Resources stands out in medical billing. We provide a complete business solution encompassing all aspects of medical billing and practice management, all within one fee structure. This includes everything from the services and benefits to the overnight shipping of your demographics.

Our fees are competitive, below the national average. Our aim is to maximize your claims' return without compromising on service or patient support, offering exceptional value.

Expert Podiatry Billing Services by 5 Star

Our team of specialized podiatry billers and coders are continually educated in the latest Podiatry coding standards to guarantee a high first-pass rate. Serving a diverse clientele across all 50 states, we cater to a variety of hospitals, physician practices, and medical billing companies. Our coders demonstrate proficiency in ICD-9/10, CPT, and HCPCS coding, adhering to both CMS and AMA guidelines. They hold certifications from the American Academy of Professional Coders (AAPC), ensuring top-notch expertise in their field.

Optimal Practices in Podiatry Billing and Coding

Prior Authorization: In Podiatry, authorization denials are frequent. It's crucial to secure prior authorization from payers and include the authorization number with the claim for successful reimbursements.
Referring Provider Information: When billing for Medicare, it's important to list the provider's codes below the CPT codes.
Accurate Medical Coding: Clean claim submission relies heavily on precise medical coding. Providers should bill additional procedure codes according to the payer's guidelines, ensuring separate billing where necessary.
Medical Necessity Verification: The coding team must be adept in using the correct CPT and diagnosis codes following established guidelines. The codes should align with NCD (National Coverage Determinations) and LCD (Local Coverage Determinations), and the documentation should support the medical necessity of billed services and treatments. Thorough documentation aids in contesting unpaid claims.
Inclusive Services Handling: Many claims are denied due to procedures being considered inclusive. To avoid such denials:
- Avoid billing CPT codes 11719, 11721, and G0127 together.
- If a claim is denied despite correct modifiers, review and appeal based on Correct Coding Initiative (CCI) edits with relevant medical records.
Service Frequency Considerations: Routine foot care services are typically deemed medically necessary every 60 days. Claims for more frequent services within this period are often denied as excessive. Appeals for these claims should be supported with medical documents justifying the need for the services.
Utilization of Q Modifiers: Claims with Q modifiers (Q7, Q8, Q9) effectively convey patient condition findings, essential for billing podiatry services.

The Use of CPT Codes for Podiatrists in America

Current Procedural Terminology (CPT) codes are standardized medical codes used to document medical, surgical, and diagnostic procedures and services. These codes are essential for a variety of stakeholders including health insurance companies, healthcare professionals, hospitals, patients, and accreditation bodies.

For podiatrists and other healthcare professionals, the use of CPT codes is crucial. It allows for the uniform documentation of services provided, a necessity for health insurers who handle over 5 billion claims each year. Accurate and consistent data capture is vital for the processing of claims across Medicare, Medicaid, and other health programs.

CPT codes, used alongside ICD-10 codes, help record the services rendered to a patient in their medical records. These records are then submitted to payers (usually health insurance companies) for reimbursement. CPT codes are typically five digits long, composed of either all numbers or four numbers and one letter.

With about 10,000 CPT codes in use, along with ICD-10 codes, they form the foundation of medical billing. Podiatrists must stay updated with the latest versions of these code sets to avoid claim rejections due to outdated or incorrect coding.

In the United States, podiatrists must adhere to typical medical coding and billing guidelines, plus three specific conditions:

Claims involving complex conditions should include the diagnosing physician's name and the severity of the diagnosis.
Non-covered services, regardless of the provider, are not eligible for reimbursement.
Payments for services integral to a covered procedure are reimbursable, even if the incidental service itself is excluded.

Podiatry Medical Billing Code Cheat Sheet

Below is a handy reference list of crucial podiatric medical billing codes for quick access for American billers.

Routine Foot Care Services

For in-office procedures and toenail treatments in podiatry, use the following codes:

99203 – 99204: New patient consultations
99213 – 99214: Follow-up visits for established patients
29405: Application of a non-weight bearing short leg cast
Q4038: Short leg cast supply
20550: Injection into tendon sheath or ligament
J3301: Treatment with Triamcinolone acetonide
11720: Trimming of toenails (one foot)
11721: Trimming of toenails (both feet)
11730: Complete toenail removal

Surgical Procedures

Relevant procedure codes include:

11750: Permanent removal of a toenail
97597: Debridement of an open wound
17110: Removal of up to 14 benign warts or lesions
28450: Treatment for a bone fracture
12001: Simple repair of a superficial wound (2.5 cm or less)
28285: Correction procedure for hammertoe

Orthotic Treatments

For billing orthotic treatment claims, utilize:

L3020: Custom-made orthotic materials (OR002)
29799: Casting and impression fitting (S0395)
97760: Orthotic management and training (per 15 minutes of Durable Medical Equipment)
L4360: Ottobock Pneumatic Walker (immobilization boot) (SS406)
L4396: Plantar fasciitis treatment (foot night splint) (SS397)
L1902: Ankle brace (SS243)

What's Covered Under Medicare and Private Insurance?

Medicare and Medicaid Services' Coverage Guidelines

The Centers for Medicare and Medicaid Services (CMS) explicitly outlines the services it will cover for patients. Although Medicare's policies do not directly dictate private insurers' coverage, they significantly influence industry standards through the Correct Coding Initiative and similar measures.

Medicare typically covers treatments deemed medically necessary or reasonable foot care services provided by clinics. However, to receive Medicare reimbursement, providers must demonstrate the medical necessity of the treatment, adhering to Medicare’s stringent criteria. These terms limit coverage for frequent services, set specific guidelines for treatment settings, and require precise diagnosis codes.

When all Medicare criteria are satisfied, covered podiatric services include:

Chronic condition-related foot care treatments
Wound care services
Hyperbaric oxygen therapy for particular lower extremity wounds
Wart treatments

Medicare excludes coverage for elective podiatry services outside reasonable foot care. Other treatments typically not covered include:

Routine check-ups not part of an initial diagnosis (except for exams with Q8 codes for metabolic, neurologic, or peripheral vascular diseases)
Foot subluxation treatments
Flat foot care
Supportive devices, except orthotic shoes as part of a leg brace and therapeutic shoes for diabetics

Private Insurance Policies

Private insurers develop unique policies regarding podiatry claim coverage. These policies include a variety of specific coverages, exclusions, restrictions, and clauses, creating complexities in understanding which services are covered for patients.

Coverage varies per individual's plan, considering their medical history, local coverage determinations, and prior authorization terms.

Generally, private insurers align with Medicare’s principles for podiatry billing and coding. However, coverage for inclusive procedures may vary among insurers.

Focusing on Blue Cross Blue Shield Association, which insures over 115 million Americans, we find a broad spectrum of covered procedures and treatments. With precise coding, Blue Cross Blue Shield provides coverage for:

Diabetic foot care
Fungal nail treatments
Foot and ankle surgical procedures
Ankle or foot injury treatments
Wart removal
Durable medical equipment
Aspirations or injections
And other services

Blue Cross Blue Shield and similar private insurers often reject claims for elective treatments.

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