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The Effect of Changes in Medicare Reimbursement on Podiatry

Any medical illness related to the foot, ankle or lower leg comes under the umbrella of 'Podiatry.' Insurance from Medicare for this field is usually covered under certain fulfilled conditions: Medicare Part B covers for treatment which is necessary and complies of chronic conditions (e.g. hammer toes, bunion deformities, and heel spurs). However, it doesn't cover for routine foot care services (treatment of corns, calluses etc.), unless it has to do with chronic cases such as for diabetics. Also, diabetics or those using therapeutic shoes/inserts having foot ailments are usually covered differently by Medicare Part B. Usually 80% of the reimbursements are covered and the rest 20% is paid by the patient and deductibles are applied. However, Medicare Part C Medicare Advantage Plan covers aspects included in part A, Part B and sometimes can deal with expanded coverage, including different plans for co-pays. However, for any of these to be covered, two requirements are absolutely essential: the foot care must be 'medically necessary' i.e. the condition must be prescribed by a licensed practitioner, and this practitioner must be a participating member of Medicare.

Medicare models:

Podiatric physicians and surgeons are looking towards joining multispecialty groups or larger hospitals/healthcare centers, due to the ever changing reimbursement schemes for them and/or sometimes outsourcing from podiatry billing companies (outsourcing), also known as podiatry RCM outsourcing.
As solo practitioners are usually competing for dollars and an influx of patients, also due to higher deductibles, it is difficult to stay in a private practice. Lately, the Sustainable Growth Rate (SGR) model has been done away with for podiatric physicians and been replaced with Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. This system rewards efficiency, quality and innovation. Further, measures such as MACRA are designed to address safety, clinical care, population health, and care co-ordination and experience between patient and caregivers.
There are numerous documents that are usually attached to a bill but MACRA creates a time-table that ensures a 0.5% increase in fee-for-service payments (valid till 2019). For this, practitioners must choose the Merit-Based Incentive Payment System (MIPS) or other payment models such as bundled payments, value based reimbursements, patient-centred medical homes, accountable care organizations etc. As these programs are metrics based, they encompass high quality and lower prices. With government funding and setting of goals, requirements must be simplified to make way for counter-productive regulations like Meaningful Use. However, for some time, the fee-for-service model will stay even if there is a transition period to other models.

The PQRS models needs proper implementation and podiatric practitioners support this system along with others such as Value Modifier (VM), Meaningful Use etc. And though PQRS is time

consuming, it aids in avoiding a 2% payment reduction from Medicare. However, many practitioners feel that it is not worth the trouble to be taken for just 2%.

Reimbursements related to ICD-10 come with its own advantages and disadvantages. Though ICD-10 comes with coding to the highest specificity, it makes it easier for accurate reimbursements. However, due to the inclusion of CMS/CDC laterality and the seventh digit, it tends to make the podiatry coding burdensome along with increased practice cost and lower productivity. Hence, it benefits payers, aids in analyzing healthcare costs, and monitoring outcomes with better performances. Also, extensive code translation ratio of one to ten, have been especially discouraging for routine foot care and therapeutic shoe claims.

Another practice being followed by podiatric physicians is cash-for service. And here, the practice must account for all-inclusive care such as small operating rooms, pharmacies, and therapy departments, and hospitalization only for the extremely sick and trauma surgeries. With the advent of anesthesia medications, it is all too possible for podiatric physicians to offer office-based surgeries and keep the procedures effective, short and patients ambulatory.

Global time frames for surgical procedure codes are usually 10 or 90 days, however these might be eliminated in the future and may reduce reimbursements for podiatric physicians. Thus APMA must ensure that new developed models will give podiatric physicians their due with respect to their contribution to patient care.

Medical Billers and Coders can however, come to the rescue of podiatric physicians for timely and apt reimbursements by providing podiatry billing and coding services. They are aware of the accurate codes and modifiers used in podiatry for accurate billing such as 76881, 76882, 93922 etc. Medical Billers and Coders aid in realizing bills for Reconstructive rear-foot and ankle surgery, Sports medicine, Diabetic limb salvage and wound care service, Podo-paediatric services, and Forensic podiatry services too. Pro-active podiatry revenue management ensures best practices are followed and physicians gain timely and suitable reimbursements.

Published By - Medical Billers and Coders
Published Date - Oct-21-2016 Back

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