The senior population in the United States (ages 65 and older) is projected to see a 47% increase by 2050. This demographic shift, coupled with the rising incidence of diabetes and obesity, is leading to a surge in foot-related issues, driving a higher demand for podiatry services.
The global podiatry service market is expected to grow steadily, with a Compound Annual Growth Rate (CAGR) of 3.6%. By 2034, the market value is anticipated to reach US$ 6,077.7 million, up from US$ 4,845.2 million in 2024.
Is your podiatry practice billing workflow prepared to meet this exponential growth?
Podiatry medical billing codes cover multiple services, from in-clinic care and nail procedures to orthotics, surgeries, and routine foot care, making the billing process taxing. Nevertheless, implementing best practices and streamlining the medical billing process guarantees full reimbursement for your efforts, allowing your practice to thrive in this expanding market. Let's uncover strategies to overcome hurdles in podiatry billing and effortlessly master them.
Efficient medical billing is the engine that powers a thriving podiatry practice. Even if your practice is highly regarded in your community and consistently busy, true success hinges on more than just patient volume — it also depends on financial sustainability.
A robust billing process guarantees optimum charge capture, ensures regulatory compliance, and drives operational efficiency. Without it, even the most skilled practitioners can find themselves struggling to meet the needs of their patients.
Here are some best practices in podiatry billing that guarantee enhanced financial health, streamlined operations, and regulatory compliance.
Podiatry is a specialized field, and when it comes to insurance eligibility verification, it can be a bit of a maze due to the intricate coverage regulations set by different health insurance plans. One of the biggest headaches for podiatry practices is dealing with claim denials caused by mismatches in insurance coverage.
Medicare typically covers only medically necessary treatments, including foot care for patients with chronic conditions, wound care, hyperbaric oxygen therapy, and wart treatments. In contrast, private insurance companies have specific policies, including unique coverages, exclusions, restrictions, and clauses for podiatry claims.
Given these variations, a thorough insurance verification process is crucial for ensuring proper reimbursement. Implementing a comprehensive verification process — both during appointment scheduling and on the day of the visit — helps clarify financial responsibilities, like deductibles, copayments, and coinsurance. This proactive approach prevents disputes, streamlines administrative workflows, and alleviates the burden of patient collections.
Handling prior authorization in podiatry can be a bit of a puzzle because different insurance payors have specific coverage criteria that undergo frequent updation. This adds a layer of complexity to your billing process, making it crucial to stay informed and vigilant before delivering care.
Besides treatments and procedures, prior authorization is often required for durable medical equipment such as orthotics, custom braces, and prosthetics. Check prior authorization requirements for DME to avoid delays and ensure timely delivery of necessary equipment to patients.
Understanding the prior authorization criteria prevents unnecessary denials, ensuring prompt treatment. It also allows you to effectively communicate the patient's financial responsibilities (out-of-pocket costs), improving patient experience.
Detailed and accurate documentation provides a clear and complete picture of the care provided and the medical necessity, making it easier for insurance companies to process and approve your medical claims. Here are key strategies to ensure robust documentation:
Precise medical coding is vital for proper reimbursement. However, the constantly evolving coding guidelines, with frequent additions, deletions, and revisions, can make accurate coding challenging.
Moreover, as new treatments and procedures emerge, staying updated and following correct medical coding guidelines is crucial.
Invest in continuous training sessions on the latest CPT, ICD, and HCPCS coding updates to help your team stay proficient and reduce the risk of errors. Conduct efficient scrubbing before claim submission to fix mismatched codes and detect omissions.
Furthermore, track reimbursement trends and payer policies. Understanding how different payers handle specific podiatry billing codes and modifiers can improve the accuracy of your medical claims.
Delayed patient collections and no-shows can drain revenue from your podiatry practice. Since every practice is unique, patients must understand what to expect when they visit you.
Establishing clear practice guidelines regarding rescheduling appointments, no-shows, and payments enables smooth operations and patient engagement. Here are key elements to address for effectively communicating your practice policies:
Bad debt can strain your cash flow and disrupt smooth practice operations. Delayed patient collections are an additional burden on your staff, hindering productivity and efficiency. Collecting payments upfront is a powerful strategy to minimize write-offs and payment delays.
Recent trends show that 75% of patients prefer digital and electronic payment options. Leverage these methods to boost patient satisfaction and encourage quicker payments. Here are some effective payment options to secure prompt payments:
Adhering to billing regulations is mandatory to comply with federal, state, and insurance guidelines. Compliance helps avoid claim denials, legal issues, fines, and penalties resulting from errors in coding and billing.
Regulatory compliance ensures your billing practices align with payer requirements and coding standards. This alignment helps prevent claim denials and rejections, strengthening the provider-payer relationship and leading to timely reimbursements.
Keeping up with podiatry billing can feel like a never-ending task. The landscape is volatile, with new billing codes, modifiers, and regulations popping up regularly. That's why continuous staff training is imperative.
Skilled staff are pivotal for smooth billing operations. They help speed up the revenue cycle and ensure prompt payments. Moreover, they can better assist patients with billing inquiries, boosting patient collections.
Ensure your training programs cover these key areas:
Denials are inevitable and can severely impact revenue cycles. Deploying a rigorous denial resolution process helps identify, address, and prevent denials, ensuring smoother operations. Here’s how to implement a robust denial resolution strategy:
Adapting to evolving regulations and maintaining compliance can be overwhelming without the right tools. Technology acts as a game-changer, automating numerous billing and coding tasks — from initial documentation to claim scrubbing and submission — thereby reducing errors and expediting the claim process.
Here are some advanced tech solutions that make a significant impact:
Podiatry billing doesn’t have to be a hassle. With the right assistance, you can mitigate errors, optimize your practice’s efficiency, and boost your revenue. Standard practice management systems often fall short, but Glenwood has you covered with solutions specifically designed for podiatrists. Our practice management tools — GlaceEMR, GlaceRCM, and GlaceScribe — can be customized to meet your practice needs, guaranteeing streamlined billing and enhanced collections while giving you more time for patient care.
Let’s team up to simplify your billing process and enhance your revenue. With the right tools, success is within reach!
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