by Jordan R. Stewart, DPM
Timonium Foot and Ankle Center
Established July 2006
Timonium, MD
As
a resident, I made a conscious effort to learn medical billing. I
read numerous articles and discussed billing scenarios with my
attending doctors. When I started my practice, I had the option of
doing my own billing or using a billing service. I never considered
a billing service. As a new practitioner and a business owner, I
recognized that learning to do my own billing would allow me to
maximize profit and comply with the guidelines set forth by Medicare
and the private insurance companies.
As you transition from residency to private practice, a new
"training program" begins. Just as it takes a few years of residency
to learn surgery, it will take time to learn billing and coding. I
have learned a lot over the past 6 months, making several mistakes
along the way, and I will only continue to learn as time goes on.
If you are not familiar with coding, review the ICD, CPT, and HCPCS
coding books. This will seem overwhelming at first, but as time goes
on you will know these codes like the back of your hand. Several
podiatry coding books exist. Invest in one or more of these texts
and read and participate in the coding forums available online.
Many doctors take the attitude that their staff will handle all of
the billing issues. Nevertheless, it is the doctor's responsibility
to know the insurance guidelines and bill in accordance with these
guidelines. If these rules are broken, you are ultimately
responsible and this could have a significant impact on your
reputation and your wallet.
For several years, a healthy 50-year-old male presented to a
podiatrist every 3 months to have a callus trimmed on the ball of
his foot. This was the only service provided and was billed to the
insurance company as an office visit for several years. After the
patient's doctor retired, the patient presented to my office for
treatment. I informed the patient that trimming the callus is not
covered by his insurance plan under the current rules, but instead
an out-of-pocket expense. The patient wrote me a letter telling me
he would only come to see me if I billed the service through his
insurance. I kindly informed him that I would not bill the procedure
as an office visit and he did not come back to my office. This
scenario demonstrates the importance of knowing the services covered
by the insurance company and billing in accordance with current
guidelines and not just what other doctors may have done in the
past. It is absolutely essential to follow the rules from the get go
so you do not have to worry about inappropriate billing and its
consequences.
Jordan R. Stewart, DPM
A PRESENT New Doc Editor
[email protected]
|
