Revenue Generation: An area of concern for podiatry practice

November 17, 2016


Remaining on top of things with regards to changes and overhauls to Podiatry medical billing and coding, and insurance industry regulations and rudiments can be an overwhelming, tedious work. The normal difficulties of dealing with Revenue Cycle Management with in-house staff can drain valuable assets out of your podiatry practice, shifting your focus from the patient care, and the general patient experience. Keep in mind that slip-ups and oversights in medical coding and on insurance claims can likewise be exorbitant, and result in postponed or denied claims, ultimately generating lesser revenue.

A tricky practice to code for…

Podiatry medical coding and billing has dependably been precarious and dubious due to medical necessity prerequisites from Medicare and other healthcare insurance providers. Most number of insurers reimburse for the treatment of condition of the foot, and not for the preventive care. For example, routine foot care in patients with no side effect is not secured by the insurance providers. This reimbursements confinement hassled to disarray and complexities in diagnosis and CPT coding of foot conditions, and it is presently important to demonstrate that the treatment given is restoratively important to the patient.

Nail Debridement and Its Payment Predicament

Medicare improperly paid about $96.8 million for nail debridement and related podiatry procedures in the decade starting from 2000-2010. Nail debridement was a fourth of the majority of the Medicare reimbursements to podiatrists in that period, and of the $1 billion paid to podiatrists, $233 million were paid for nail debridement; where $96.8 million of that $233 million was paid improperly, and 22.7% of the insurance providers around then had no medical justification. To control this uncontrolled practice, Medicare made particular claim rules and guidelines identified with foot care that one needs to follow consecutively for CMS to recognize the claim.

Is routine foot care a covered benefit or not?

Routine foot care to patients with no side effects is not a secured benefit. For example, treatment of plantar keratosis, bunions, corns, calluses, nails (with exception of surgery for ingrown nails) and other sterile and maintenance care to bed-confined or Ambulatory patients goes under routine care which is not secured. Despite the fact that there are exemptions like on account of foot care for systemic conditions that outcome in sensory loss (diabetes, arteriosclerosis obliterans, thrombophlebitis, spinal cord damage with paraplegia or quadriplegia), the systemic disease should be of extreme seriousness whose non-proficient treatment could be dangerous for the health of the patient. The point here is that with such undoing, it is the Podiatrist who is at the losing end of things. This can derail the income cycle, which mean lower revenue generation.

Podiatry as a practice is brilliant medical profession that can make doctor's earn some handsome revenue at the end of each month. However, with changes leading into the 2017 CMS requisite, foot care revenue management and generation needs a able partner to streamline the overall work proceedings. In such a scenario, availing the services of an outsourced podiatry medical billing and coding agency can work as a sorted plan to minimize expenditure and most importantly reduce the coding errors. Certified billing and coding professional help you leverage the foot care management, and in-turn makes you concentrate on the most important thing of your job, which is patient care and consideration.


Category : Best Billing and Coding Practices