Running a successful podiatry practice goes beyond just providing excellent patient care. Every aspect of the practice, from administrative work to patient management, plays a vital role in ensuring the business thrives. Among these, one of the most crucial yet often overlooked areas is billing. Efficient billing not only impacts your practice’s profitability but also ensures a smooth workflow, reduces financial stress, and maintains patient satisfaction.
While there are several general medical billing services available, when it comes to podiatry, choosing a billing company that specializes in the field is essential. Podiatry billing is different from other medical specialities, and opting for a billing company that understands the unique needs of podiatric practices can make a significant difference in your practice’s revenue cycle. Let’s dive into the reasons why podiatry-specific billing is a must for your practice.
1. Podiatry Has Unique Coding and Documentation Requirements
Podiatric care is far from being a “one-size-fits-all” service, and neither is its billing. Procedures in podiatry are distinct from those in other specialities, such as family medicine, cardiology, or orthopaedics. From nail care to foot and ankle surgeries, every procedure has its own set of codes and billing requirements.
Take, for example, common podiatric services such as:
- Nail debridements (CPT codes 11720, 11721) – These procedures, often required for patients with fungal nails, involve removing diseased or damaged nail tissue.
- Mycotic nail testing (CPT codes 87798, 87101) – Fungal infections in the nails require specialized tests, each of which has its own billing codes.
- Foot and ankle surgeries (CPT codes 28285, 28485) – From bunion corrections to complex ankle surgeries, these procedures come with specific billing requirements to ensure proper reimbursement.
- Wound care and diabetic foot exams (HCPCS codes G0245, G0247) – Diabetic foot care is critical in preventing serious complications, and accurate coding ensures appropriate reimbursement.
A general billing company may not be fully familiar with these codes or how frequently they change, especially as guidelines evolve from Medicare, Medicaid, and private insurance providers. A podiatry-specific billing company, however, is constantly updated on the latest coding practices and ensures that all claims are submitted accurately, helping you avoid denials and maximize reimbursements.
2. Better Handling of “At-Risk Foot Care” and Routine Care Rules
Podiatry practices often deal with Medicare guidelines that include specific rules for “at-risk foot care,” especially for elderly and diabetic patients. These rules are far more nuanced than what general medical billing services are accustomed to. Key challenges include:
- Class findings – Specific documentation of patient conditions is required to ensure proper coverage, such as documenting that a patient has diabetic neuropathy or poor circulation.
- Covered vs. non-covered diagnoses – Determining which diagnoses are covered by insurance for routine care can be tricky. A general billing service might miss key details and file claims incorrectly.
- Proper use of Q modifiers and diagnosis linking – The correct use of modifiers such as Q7, Q8, or Q9 is essential for differentiating the type of foot care and ensuring claims are processed without delays.
An experienced podiatry billing specialist knows these nuances inside and out, ensuring that your claims are filed correctly and in compliance with the guidelines the first time, preventing unnecessary denials or audits.
3. Faster Payments and Fewer Appeals
One of the major pain points for any medical practice is delayed payments or having to spend excessive time appealing rejected claims. With a podiatry-specific billing service, you can avoid these issues altogether. Billing specialists in the field know how to:
- Preemptively attach supporting documentation – Proper documentation is essential for timely payment. Specialists understand what’s needed to support your claims from the start.
- Properly use modifiers like 59, 25, and KX – Correctly applying modifiers is crucial for billing multiple services on the same day or for proving medical necessity.
- Bundle and unbundle services according to carrier rules – Certain services need to be bundled or separated based on the payer’s rules, and billing experts ensure these services are billed correctly.
These practices result in:
- Fewer rejected claims – With the right information and modifiers in place, claims are less likely to be rejected.
- Fewer delayed payments – Proper coding and documentation mean that claims move through the process faster.
- Significantly less time spent appealing errors – With fewer errors to begin with, the time spent on appeal processes is drastically reduced, leading to better cash flow for your practice.
4. Support for Audits and Complex Cases
Even with the best practices in place, audits can happen. Whether it’s a routine foot care audit or one triggered by surgical procedures, dealing with audits requires specialized knowledge and experience. A podiatry billing company has the expertise to handle audits effectively, offering the following services:
- Provide proper documentation support – Specialists are well-versed in the documentation required to support various podiatric services, ensuring that you can back up your claims during an audit.
- Defend the claims with speciality knowledge – Podiatry billing experts are familiar with the intricacies of podiatric care and can defend your claims during an audit with confidence.
- Guide your staff through corrective action if needed– If an audit reveals errors in your billing practices, a podiatry-specific company can help guide your team through the process of correction to prevent future issues.
General medical billers may not have the in-depth knowledge required to handle these situations correctly, but a podiatry-specific billing team is prepared to ensure that your practice remains compliant and successful.
5. We Speak Podiatry — So You Don’t Have to Re-Train Us
When you partner with a podiatry billing team, you avoid the need to explain basic podiatry concepts. You won’t have to spend hours re-training a billing company about the specifics of podiatric care, such as:
- Hallux Valgus repair – A common bunion surgery that requires detailed coding for accurate reimbursement.
- Hammertoe correction vs. metatarsal osteotomy – Two different procedures requiring different approaches in billing to ensure proper reimbursement.
- Diabetic foot care – Even when nails “just look thick,” this care is crucial to preventing complications, and a podiatry-specific billing team understands the medical necessity of these treatments.
By partnering with experts who already understand these terms and the complexity of podiatric care, you can save your office staff valuable time and ensure that your billing is handled efficiently and correctly from the get-go.
Ready to Step Ahead?
At SMB, we specialize in podiatry medical billing services, helping practices like yours maximize collections, reduce denials, and stay compliant with industry standards. If you’re tired of spending time teaching your biller the intricacies of podiatry, it’s time to consider making the switch to a specialized service.
Look no further—partner with SMB as your podiatry-specific billing company, and let’s discuss how we can help your practice take the next step toward improved revenue cycle management. We speak your language, and we’re ready to help your practice succeed.
