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Podiatry is certainly a complex specialty for revenue cycle management;
Between the rules for procedure types and benefits limits, we have often found podiatry practices losing significant amounts of revenue for manageable denial types.
Our team at Etransmedia has the knowledge and skills necessary to successfully work denials and provide our podiatry clients with valuable feedback to assist in managing and decreasing the most frequently seen denial types. We have narrowed our focus to the various rules and guidelines issued by the insurance carriers to assist our clients in streamlining their revenue and decreasing their rejections and denials. Getting you paid fast!
What we know…
Specific procedure coding and billing requirements: An excellent example of specific procedure type requirements deal directly with routine foot care. In many jurisdictions, routine foot care (11721) must be billed with a systemic condition for payment. Even beyond that, Medicare claims are required to have the Primary Care Physician and Date Last Seen on the claims directly for any reimbursement at all. It is vital that the physician office and the billing team be in clear and direct communication to make sure that this information is being obtained and transmitted.
Time limits of procedure frequency: Many of the procedure codes billed for podiatrists have set post op periods that carriers will observe to the exact day. Routine foot care usually requires a sixty day lapse before the patient can be seen again for the procedure.
Modifier order and use: Because so many of the CPT codes for podiatry are specific to foot/toe/nail, it is important to note this information on the charges at the time of service. This includes designating the correct foot (LT/RT), the toe (T1-TA), in addition to the class findings (Q7-Q9). Carriers require that certain CPTs have this information in order to review the claim and process it for payment. It is a small, but vital, step in the billing process.
On October 1, 2016 the Centers for Medicare and Medicaid Services (CMS) will no longer accept unspecified codes in most cases.
Starting in October, CMS requires greater specificity for claims filed in ICD-10-CM/PCS. The 12-month grace period originally introduced in 2015 said they would not deny claims for lack of ICD-10 specificity. That all changes on October 1, 2016. Payors will most likely follow suit if they haven't already.
First Pass Clean Claim Rate
Boost in Revenue*
Reduction in Cost*
We’re always on top of all the latest coding and billing updates for Podiatry practices. Additionally, to make sure all claims are reimbursed on the first claim submission, our system is able to pre-edit claims prior to the initial submission for possible billing/coding errors. Our detailed end of month reports keep our clients up-to-date on what is happening in their practice so any issues can be addressed quickly. By working closely with our clients, Etransmedia has established a knowledgeable and experienced team of podiatric billing specialists, who work hand in hand with our podiatry clients each day to help make their practice successful.
Although the new industry standards can be confusing and difficult to navigate, our dedicated team here at Etransmedia can assist in guiding you and helping to make your practice grow successfully.
*Please Note: Results are not guaranteed, implicitly or explicitly, and will vary based on several factors such as individual practice demographics, specialty, payer mix, operations, and management among others
Service and Technology Packages
Our customizable revenue cycle management service and technology solution packages allow you to outsource based on the specific needs of your practice
Silver RCM Service
This package has the core service and technology needed for revenue management allowing you maintain the responsibility of patient billing.
Gold RCM Service
This package includes the core RCM services with added denials, A/R management services, and full service patient billing
Ancillary RCM Services & Technology
Available to enhance any package