Just curious but what is the starting salary of a podiatrist working JUST in a nursing home right after 3 year residency? I couldn't find a thread that really answers it. Thanks!
$350k
So a visit to a nursing home with routine foot care provided would gross $37 (give or take a few bucks) per patient?
Nope. You can only charge visits for new patients, if there is something OTHER than nail care you're seeing the patient for, which requires a new order, OR once a year, Medicare allows an office visit as a "re-evaluation".
So really, for your regular nail care patients you see every 2 and a half months, you're getting $7.
I'm afraid that if this is how Kidsfeet is billing, he may have short-changed himself a significant amount of money over the years. I will also preface the fact that our office does a few nursing homes and follows the rules VERY closely and "plays by the rules".
Let me clarify.
When treating nursing home (or any office patient) for palliative care, there are several codes that are billable and here they are;
11719 which is essentially the trimming of healthy, non dystrophic/non mycotic nails. This pays between $12-19 depending on locality.
11720 which is the debridement of mycotic nails up to 5 nails. This can be approximately $24
11721 which is the debridement of 6 or more mycotic nails. This pays in the range of $34
11055 which is the trimming of a keratotic lesion. This pays in the range of $20 (I may be wrong)
11056 is the trimming of 2-4 keratotic lesions. I believe this pays in the $40 range.
11057 is the trimming of greater than 4 keratotic lesions. I believe this pays over $45.
Now is when it gets tricky. You can bill several of these together WHEN appropriate;
You can bill the following scenarios;
11719 and 11720 together
11719 and 11720 with ONE of the following 11055, 11056 or 11057
11721 by itself
11721 with ONE of the following 11055, 11056 or 11057
You can NOT bill 11719 with 11721 and can NOT bill 11720 with 11721.
Additionally, for the majority of these codes the patient must meet the guidelines of "class findings" such as decreased or absent pulses, decreased or absent hair growth, trophic skin changes, edema, temperature changes, etc., and must have a qualifying systemic condition such as PVD, diabetes, etc.
So, as you can see, IF a patient has one or two mycotic nails and a callus or two, your LEGITIMATE billing for that patient is substantially greater than $7.
And I believe it's safe to say that there are very few geriatric patients in these facilities who have 10 perfect toenails without some form of pathology/mycosis. Our office was even performing cultures to CYA on these cases to justify the billing.
I'm afraid either Kidsfeet has underbilled and passed on a significant amount of money, or his patient population has greatly beaten the statistics by having perfect nails on every patient!!
I'm afraid that if this is how Kidsfeet is billing, he may have short-changed himself a significant amount of money over the years. I will also preface the fact that our office does a few nursing homes and follows the rules VERY closely and "plays by the rules".
Let me clarify.
When treating nursing home (or any office patient) for palliative care, there are several codes that are billable and here they are;
11719 which is essentially the trimming of healthy, non dystrophic/non mycotic nails. This pays between $12-19 depending on locality.
11720 which is the debridement of mycotic nails up to 5 nails. This can be approximately $24
11721 which is the debridement of 6 or more mycotic nails. This pays in the range of $34
11055 which is the trimming of a keratotic lesion. This pays in the range of $20 (I may be wrong)
11056 is the trimming of 2-4 keratotic lesions. I believe this pays in the $40 range.
11057 is the trimming of greater than 4 keratotic lesions. I believe this pays over $45.
Now is when it gets tricky. You can bill several of these together WHEN appropriate;
You can bill the following scenarios;
11719 and 11720 together
11719 and 11720 with ONE of the following 11055, 11056 or 11057
11721 by itself
11721 with ONE of the following 11055, 11056 or 11057
You can NOT bill 11719 with 11721 and can NOT bill 11720 with 11721.
Additionally, for the majority of these codes the patient must meet the guidelines of "class findings" such as decreased or absent pulses, decreased or absent hair growth, trophic skin changes, edema, temperature changes, etc., and must have a qualifying systemic condition such as PVD, diabetes, etc.
So, as you can see, IF a patient has one or two mycotic nails and a callus or two, your LEGITIMATE billing for that patient is substantially greater than $7.
And I believe it's safe to say that there are very few geriatric patients in these facilities who have 10 perfect toenails without some form of pathology/mycosis. Our office was even performing cultures to CYA on these cases to justify the billing.
I'm afraid either Kidsfeet has underbilled and passed on a significant amount of money, or his patient population has greatly beaten the statistics by having perfect nails on every patient!!
Those numbers had me checking medicare reimbursement as well.......I was hoping he was wrong. What a slap in the face to get paid $7 for medical care. Thats the gubment for ya'
Many plans are paying a little under $6 per pt for repeat visits. Some plans are paying a little under $12 per pt for repeat visits. A small number of plans pay over $20 per pt per repeat visit.
One would need to be independently wealthy or win lotto to be able to afford to do this job long term.
First of all, what is the definition of a repeat visit. I've been involved in this profession for a long time, and there is NO code for a repeat visit.
You are supposed to code for whatever service(s) you provide. If you are there as a repeat visit to follow up for an ulcer, and that involves a debridement of the ulceration(s), you are expected to bill the new ulcer debridement code and of course document accordingly, including the size and characteristics of the ulcerations(s), type of debridement, instrument used to debridement, type of medication applied, type of dressing(s) applied, just to name a few things, as well as the follow up care.
If you are there to provide repeat palliative are for a patient who qualifies due to a systemic disease such as diabetes/peripheral vascular disease, etc., and who also meets the class findings, most insurance carriers will pay for these services every 61 days. You are expected to bill the appropriate "nail" codes and/or trimming of keratotic lesion codes as explained in a prior post.
You are NOT expected to bill a visit code at the same time as one of the above, unless you have provided a separately identifiable service for another problem.
If you are treating a patient for a repeat visit to follow up for an infection, tinea pedis, etc., then you would simply be a "visit" code, and would bill the appropriate code according to the amount of time spent with the patient, the amount of decision making and how much was in your documentation, etc.
But there is no "repeat" visit code.
If you are treating nursing home patients and consistently getting reimbursed $6, $12, etc., and/or are billing for visit codes often, you are doing something wrong and need to take a course in proper billing.
Believe me, I know of NO ONE who would waste their time for those fees unless they were independently wealthy and providing services out of the kindness of their hearts.
As I stated before, if I was getting reimbursed those fees, I would rather provide gratis care to those really in need.
Once again, I've read many of your posts and have read how you make no money, etc., etc., and this may be just one of the contributing reasons. Most of our nursing homes are serviced by subcontractors or associates for our office, and we would not be able to pay them if that's what they were billing. We don't tell them how to bill, but we do watch to make sure what they do is "kosher" and legal. If you have any questions regarding billing, PM me and maybe I can teach you how to earn a little more income legitimately. It appears you need help.
.
To clarify for you. Repeat visit = nail care.
Thanks for the offer. I may be looking for work at some point.
If you are/were receiving those low figures for your palliative care services, you may want to read one of my prior posts to explain why those figures are not consistent with what our practice or any practice I'm aware of receives.
If you read the APMA news or other journals that have recently been advertising for DPM positions for nursing home work, they are offering relatively generous salaries and benefits. I'm confident that they couldn't offer those numbers if they were receiving the reimbursements you've mentioned.