Even though podiatrists’ daily appointments are always full, it doesn’t mean they always get full reimbursement. Foot and ankle care clinics are one of the most scrutinized and underpaid specialties due to inefficient podiatry revenue cycle management (RCM). Strict Local Coverage Determinations (LCDs) and complex modifiers play a vital role in how much you get paid and how quickly.
Outsourced podiatry billing services offer various benefits if the decision is taken after thorough evaluation. Partnering with a wrong or inexperienced billing partner can cause podiatry revenue leaks, resulting in elevated days in AR, erroneous billing and coding that slowly erodes your bottom line. This blog guide highlights 5 red flags that you must consider when choosing a reliable podiatry medical billing company. You will be able to lower claim denials, accelerate revenue cycle and billing process when supported by an experienced medical billing team.
Red Flag #1: They Are Generalists Who Lack Podiatry-Specific Coding Expertise
If you partner with a generalist medical billing company, you will get the general results also. Applying generic billing techniques for specialized disciplines like podiatry will surely lead to lost revenue and compliance issues.
The Hidden Cost of General Coding
In the absence of dedicated podiatric billing experts, medical coding teams can misinterpret routine foot care coverage rules, leading to claim denials. Generic billing and coding teams often fail to understand the difference between routine foot care and systemic condition-induced care for conditions like diabetes, peripheral neuropathy, and lower limb vascular disease.
Provider Checklist: Specialty Verification
Here’s the checklist to evaluate specialty expertise of your future billing partner:
- Ensure outsourced billing company has dedicated podiatry billing experts
- Check if their team knows about regional podiatry LCD policies
- Verify if they have complete knowledge of foot and ankle modifiers
Red Flag #2: Frequent Misuse (or Omission) of Podiatry Modifiers
Precision in medical coding is the backbone for establishing a healthy revenue cycle. When billing companies omit or fail to apply proper modifiers, cash flow gets stalled for weeks or even months.
The Cost of Improper Modifier Billing
If a billing team is unfamiliar, inexperienced in the use of podiatry modifier Q7 Q8 Q9, or CPT modifier 25 podiatry, they will trigger claim rejection on every claim submission. Untrained billing staff can make costly mistakes in Medicare nail debridement and routine foot care claims. Submitting claims without verifying class finding are rejected by automated claim scrubbing tools, leading to lengthy reworks, and denials.
Provider Checklist: Claim Scrubbing & NCCI Edits
Here’s the useful checklist for modifiers and NCCI edits.
- Ask how the billing team performs the pre-submission audits for modifier and NCCI edits.
- Demand the staff should have an automatic validation system for documenting systemic conditions like diabetes, peripheral neuropathy, etc.
- Check whether they have podiatry claim scrubbing tools appropriate for catching unbundled procedures and audit risks.
Red Flag #3: A/R Over 90 Days Is Ignored
When the billing team fails to properly address accounts receivable past 90 days, the backlog becomes so big that force practices to choose write-offs than pursuing claim reimbursement:
The Threat of Neglected Aging Accounts
When the billing team has inexperienced staff members, they solely focus on initial claim submission, leaving claim rejection and denial follow-up on hold. This results in an account receivable backlog that must be cleared for financial stability of the healthcare facility. If the claim appeal window is missed, the claim ages beyond 90 days, it becomes almost impossible for payers to reimburse for care services.
Provider Checklist: Denial Protocol Requirements
Here’s the checklist for assessing how your billing partner is processing claim denials:
- You must demand a clear protocol from the billing partner to target ARs aging 90 days.
- They must have a dedicated team to tackle claim denial and rejections within 24-48 hours.
- Ensure front-end podiatry claim denials strategies exist to facilitate patient balance and deductible collection process seamless.
Red Flag #4: Opaque Reporting with Zero Visibility into Key Performance Metrics
Without real-time oversight over your revenue cycle performance, podiatry practices are basically working in blind. Opaque performance reports are some of the big medical billing red flags hiding the true potential of your practice and how payers are seeing it.
The Dangers of Hidden Performance Data
When you select a medical billing partner that offers low quality services, they typically hide the low collections and poor performance behind monthly deposit summaries. This prevents you from accessing true performance data about your revenue cycle, and how you should optimize your practice to stop revenue leakage.
Provider Checklist: Essential RCM Benchmarks
Before signing the final contract insist to your billing partner for providing monthly KPI report that must include the following benchmarks:
- Transparent dashboard access to monthly clean claim rate for podiatry procedures.
- Days in AR must be less than 30, Net collection rate above 98%
- Denial trend of top payers and their reasons for rejections.
Red Flag #5: Inability to Properly Bill High-Value Specialties (DME & Wound Care)
High-value DMEPOS services like custom orthotics, AFOs, surgical shoes, and wound debridement follow strict billing rules. Incomplete documentation expose the podiatry practices to audits:
The Risk in DME and Wound Care Claims
General billers fail to capture charges and mostly mishandle durable medical equipment DME billing, especially CPT 97597 claims. When the billing team fails to verify patient coverage limits, or unable to secure prior authorization before dispensing orthotics and wound care supplies, it crushes your practice’s profitability.
Provider Checklist: High-Value Billing Capabilities
Partner with a billing team that knows how perform high-dollar billing for DME items:
- Confirm the billing team has a proper system for obtaining prior authorization for billing and dispensing custom orthotics and wound care surgical supplies.
- Demand the outsource team must have expertise in diabetic wound care coding and managing strict payer coverage limits.
- The billing team must promptly obtain insurance eligibility for costly DME items and collect out-of-pocket cost from patients at point of service.
Conclusion: Protecting Your Practice’s Profitability
Outsourcing a reliable podiatry medical billing company offers various benefits if you have chosen a reliable partner that’s vetted by your peers and has a good reputation in the healthcare industry. By thoroughly checking if the billing team doesn’t comprise generalist coders, billers and managers, you steer clear of five red flags we mentioned here.
Additionally, take the help from our detailed checklist that will help you apply a systemic approach to manage the process of choosing an experienced team that has deep expertise in podiatry revenue cycle audit to minimize errors. Accurate billing, coding and timely submissions ensures full charge captures, strengthening your practice’s financial performance.
Are you looking for a dedicated team that has vast experience in managing revenue cycle especially for podiatry practices? Contact Billing Podiatry to secure your reimbursement at every stage of the billing process. Get a free audit to spot revenue leakages in your current billing procedure and increase earning by 30%. Your journey to financial success starts today.