Podiatry billing and accounts receivable

Routine foot care exclusions and systemic-condition documentation drive most podiatry denials.

Where the money leaks in podiatry

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Routine foot care denied without a qualifying systemic diagnosis
• Q modifiers for class findings missing
• Nail debridement frequency limits exceeded
• Orthotics denied for coverage exclusion
• At-risk foot care documentation not naming the treating physician for the systemic condition

What a seat does about it

One trained person works your queue from the difficult end. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing.

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and certified coding at $2,500.

The codes those turn into

Each of these is a denial code you are likely to meet working podiatry, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-22 — May be covered by another payer
  The payer thinks somebody else is primary. Until coordination of benefits is corrected on their file, nothing on this claim will pay.
  Recovered by being fixed at coordination of benefits and rebilled. Matched from: “Orthotics denied for coverage exclusion”
• CO-50 — Not deemed medically necessary
  The payer does not accept that the documentation supports the service. This is a clinical argument, not a clerical one.
  Recovered by being appealed with clinical documentation. Matched from: “At-risk foot care documentation not naming the treating physician for the systemic condition”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and about about 90% of initially denied claims are eventually paid. Most of what sits in a podiatry AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions