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Podiatry Reimbursement Cuts Expected in 2015

October 07, 2014



As is the case with any healthcare related industry, healthcare reforms will not affect the demand for podiatrists. Subsidies will help those with low income groups to gain coverage. This in turn will increase the number of insured patients and increase the demand for podiatrists. The ageing US population will also increase the demand for treatment of foot and ankle ailments.

There is a faction of people who fear that Obama care may be the end of Podiatry. However, that is not the truth. Podiatry may be taken off insurances for cost cutting purposes, but people who want to get their feet or ankle checked will still go to Podiatrists; just like when people who want to get their dental checkup go to a dentist and not a dental surgeon.

Industry Fact File

The US Podiatry industry is pegged at five billion dollars approximately and its annual growth is about two percent per annum. It employs about 53,000 people. The Podiatry industry is characterized by low barriers to entry. The frequency of many self-employed or solo practitioners suggest that barrier to entry are relatively low. These solo practitioners make about 34% of the total podiatrists. Another aspect to consider is they do not have to make large investments on medical equipments and they can also lease equipment and building which reduces the capital outlay.

Podiatry Reimbursement Cuts

Obama care led to the creation of the Independent Payment Advisory Board (IPAB). This is an unelected group of 15 individuals who will meet and decide cost-cutting methods for healthcare practitioners. The board will come up with their proposals which are to be implemented by January 1, 2015, and which can be overridden only by the Congress; but that seems to be a bleak happenstance.

There has been a proposed cut in the reimbursement on the code 11719 by half. The ramification of cutting reimbursement on 11719 is that it would hurt honest podiatrists. Usually the honest ones bill 11719 and those who do not really tow the line, bill 11721 as there is no real financial incentive to bill 11719 unless one is a really honest practitioner.

Honest nursing home podiatrists are the ones that will really get hurt due to this cut. As the newspapers suggest, a large percentage of podiatric fraud occurs at nursing homes. Let us look at a scenario which this reimbursement cut will present; there are a number of podiatrists who are working on 11719 and billing them honestly, now suddenly due to the reimbursement cut the podiatrist has to take a pay cut. Now what does one do; either they take the pay cut and continue being honest or some of these 11719 will transform to 11721. This is a perfect example of an oxymoron where the government is trying to increase their revenue but their reforms are encouraging honest practitioners to trigger up coding.

Conclusion

Overall, podiatrists may see little or no change in the reimbursements, but it is obvious that if the cuts do happen, it will change the scenario for podiatrists in the US healthcare market. Podiatrists can take help from MedicalBillersandCoders.com who can streamline processes and find ways to compensate for the reimbursement cuts. MBC is a consortium of billers and coders spread across US who provide customized medical billing services to around 40 specialties.

 

Category : Revenue Cycle Management