Podiatry medical billing requires precision and relevant expertise. Besides, providers must have knowledge about complex ICD-10, CPT codes, and Q-modifiers to submit accurate claims and get faster payments.
Providers struggle to manage billing and face unwanted administrative burden, resulting in revenue loss. As per the industry estimates, 80% medical billing organizations encounter billing errors.
This article will explore the major causes of podiatry denials including diagnosis and procedure codes mismatch.
What is Podiatry Billing?
Podiatry billing includes managing the revenue cycle and administrative work related to foot, ankle, and lower extremity of care. Accurate billing against these services ensures a smooth workflow and quick reimbursements.
However, podiatry billing is not a single step but a multi-process journey. It includes
- Patient insurance verification
- Document management
- Code assignment
- Claim submission
- Denial management
- Progress tracking
Podiatry Billing Errors
Podiatry billing errors can occur due to various reasons such as incorrect documents, wrong codes, ignoring insurance coverage verification etc. Below is the explanation of these mistakes, understanding them can help providers improve billing process flow and maximize profitability.
- Incomplete Patient information: recording incomplete or wrong patient information such as patient DOB, contact number, and insurance id directly leads to claim denials.
- Wrong CPT ICD-10 and HCCPS code selection: code assignment is a sensitive task that can impact your reimbursements. Small mistakes in writing CPT, ICD-10 or HCPCS codes increase denials, administrative burden and results in losing practice revenue.
- Misuse of modifiers: implementing incorrect modifiers also leads to revenue leakage. Common modifier mistakes include incorrect RT/LT location codes, wrong bilateral modifiers, and unnecessary modifiers.
- Ignoring denied claims: Ignoring denied claims means losing hard earned practice revenue. Healthcare experts must rectify the mistakes in denied claims and re-submit them to receive timely payments.
Reasons Behind Podiatry Billing Errors
Podiatry billing errors only increase frustration and result in losing revenue. Though providers rely on professional billing services to manage billing related issues.
However, understanding the reason behind podiatry errors can help them reduce the risk of higher workload and revenue loss.
Documentation Gaps
Podiatry healthcare Providers often ignore the importance of documentation in the medical billing. However, ignoring this simple step results in
- Inaccurate progress reports
- Incomplete documents
- Missing operative notes
Which directly leads to repeated claim denials and revenue loss. Carefully documenting every service requires time but helps experts avoid initial mistakes and streamline operations.
Inconsistences in Insurance Verification
Neglecting the patient insurance verification step is another major cause behind the podiatry billing errors. When providers fail to confirm the patient’s insurance eligibility, they experience claim denials.
Podiatry healthcare experts should maintain a standard that ensures patient verification at the first step to avoid this major error and receive faster payments from the insurance providers.
Diverse Payer Regulations
Insurance payers like Medicare and other providers have their own set of policies. For instance, two patients have different insurance coverage, therefore, providers have to understand every payer’s regulation.
Unawareness results in filing incomplete claims. Sometimes, these claims violate the rules, and providers end up facing costly penalties.
Podiatry Coding Mistakes You Should Know About
Coding remains a crucial aspect of the entire podiatry billing; it directly impacts the practice revenue cycle. Therefore, podiatry healthcare providers should learn accurate code assignments to achieve a positive financial outcome.
Moreover, understanding the coding errors is also helpful in avoiding unwanted coding mistakes and preventing the loss of precious revenue.
- Incorrect codes: Providers should know that CPT code is linked with ICD-10 code. They must receive proper training about the codes; such education will help these experts to avoid risk of denials and revenue loss.
- Inaccurate service unbundling: in medical billing, if a code covers numerous medical procedures, then experts use it during the billing. While it is called unbundling when a procedure is categorized into various parts for achieving higher reimbursements.
- Down coding mistakes: down coding refers to the coding of a lower service than actual service was performed. This only results in losing the practice revenue and making grounds for a quick practice audit.
- Physical therapy documentation: it is important to check the coverage for a patient treatment. Sometimes, a specific treatment has no insurance coverage. Therefore, prior verification can help avoid the risk of claim denials.
Strategies to Optimize Podiatry Billing
Optimizing podiatry billing is a key approach to boost operational productivity and enhance the practice of revenue. Below are the strategies healthcare providers should implement to avoid podiatry billing errors.
Healthcare organizations should use podiatry billing software to reduce human efforts and automate the data management process. A modern-day software/app comes with various functionalities, designed to efficiently perform billing tasks.
Patient insurance coverage is important for the healthcare organization’s revenue cycle. Therefore, experts should conduct an insurance verification to ensure that every patient has coverage for treatments.
Outsourcing podiatry billing practices is also an excellent strategy for the organizations to avoid hassle of workload and maximize revenue without sacrificing the revenue. Moreover, it frees their time and helps them invest efforts in other productive operations.
Final Thoughts
Understanding podiatry procedure codes is crucial to accomplishing financial excellence. However, podiatry billing is a multi-step process, and it is important to understand all aspects to reduce the risk of denial.
Healthcare experts lack knowledge about coding, the use of modifiers, and diverse payer regulations. Above we have explained all the errors, their reasons and strategies to optimize the revenue cycle.
Frequently Asked Questions
What happens when podiatry procedures and diagnosis codes are incorrect?
Incorrect podiatry diagnosis and procedure codes result in claim denials, revenue loss, and increased administrative workload.
What are the common CPT codes for podiatry billing?
- 11720: Nail Clipping (1 Foot)
- 11721: Nail Clipping (2 Feet)
- 11730: Removal of Toenails.
- 11750: Removal of Toenails (Permanent)
- 97597: The Treatment of an Open Wound.
- 17110: Benign Wart/Lesion Removal Up to 14
What are the modifiers for podiatry coding?
Modifiers for podiatry coding include Q7, Q8, and Q9 that indicate further information about footcare medical treatment necessity.
What is the meaning of DPM?
DPM refers to the Doctor of Podiatry in medical billing
What are the common problems that podiatry doctors treat?
Heel pain, ingrown, toenails and athlete`s foot.
