Specialty medical providers face many challenges due to constant billing regulations changing and increased costs to support the practice. Podiatry practice is one such specialty facing a constant conundrum of regulations and audits, these are time-consuming and lead to physicians’ fatigue. Even many of the small-scale podiatry clinics today face the challenge of resources to deal with regulatory complexities.

At Legion Healthcare Solutions (LHS), we understand the challenges each podiatry physician and even more with revenue decline for services provided. Under many circumstances, the medical insurance company can consider the foot or ankle procedure to be medically unnecessary and during such cases, the practice might have to turn towards patients for payment.

“Podiatry billing is not only unique but also a challenge to our medical billing practice, sometimes when a patient comes in for an emergency or is referred, the patient may not realize, but their insurance company feet. Or may not cover the process of the ankle. The worst-case in such scenarios is when they completely deem the procedure unnecessary.

“Legion has got a single rule prior authorization before each podiatry procure.” Podiatry Billing Manager at Legion Healthcare Solutions .”

– Certified Coder for Podiatry Billing at LHS

Prior Authorization or Insurance Verification

Even though insurance verification is just checking the patient's active coverage at Legion we have realized that checking patients' active coverage means that insurance companies are even doing a complete verification of the procedure. In podiatry billing, the initial process of insurance verification holds the key to getting paid. Verifying the patient's insurance prior to the procedure, reduces the probability of denials and increases cash flow. Practices can even inform their patients about payment responsibilities if any, making the cash flow procedure streamlined.

Podiatry Coding

Coding for podiatry billing can be a challenge if the coders aren’t well versed with the coding practices. Here are some of the most common misunderstood podiatry medical codes: For CPT, 11055 (Trimming the skin lesion), while for trimming of two to four lesion 11056 and for more than four 11057. While for debridement of nail till 5 use code 11720 and for more than six use 11721. Legion understands that coding and billing are ever-changing scenarios hence each coder must be aware of the standards and coding guidelines.

Using Modifiers

Podiatry billing deals with a simplistic view of the human body, making the procedures and billing complicated. Suitable modifiers are used to differentiate between the date of service with codes. For example, we have a set to class type of findings, where Q7 corresponds to Class A, Q8 corresponds to class B and Q9 corresponds to class C.

Denials and Appeals

According to a recent survey, podiatry billings are most likely to be underpaid or claims denied due to improper coding or lack of prior authorization. Legion before appealing for a denial goes through a set of checklists where we verify the patient's procedure and coding along with managing the EOB sent by an insurance company. An increase in AR days can lead to part-payment or even audits from the insurance companies.

A certified team of coders works on each podiatry billing.

A team of billers works 24/7 managing claims and denials.

Analytics-based solution to manage AR and AR days to keep track of each claim.

API and RPM-based solutions to improve patient care.