The future of podiatry

[619]

And the insurers ARE reviewed by quality assurance organizations. They don’t operate uncontrolled. There’s a lot more to how the insurance companies are reviewed than most people understand.

I did not know this but I wonder what punishments insurance company get for denying legit covered claims and services. They pay after we "appeal". To appeal cost PP extra cost, time and money. I let a lot of claims go because I don't have the staff or man power to appeal everything. So insurance companies make a lot of money from solo PP like me. But we are also the ones that commit fraud right.

Lastly I won't be surprised if the so called quality assurance organizations and insurance companies are in bed together because year after year nothing gets done except screwing the doctors.

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[ExperiencedDPM]

Do we have someone like you who is working on the side for the doctors/PP and fighting the insurance company on our behalf. Everyday, insurance companies routinely deny covered services from simple office visit to office procedures. Isn't that fraudulent also on the side of the insurance companies for not paying a covered service? Who is scrutinizing the insurance companies since they pay you big bucks to scrutinize us.
I understand after we appeal, then they sometimes pay with no reason whatsoever or even an apology. Insurance companies game the

system to deny a bunch of covered services and hopefully maybe half of the doctors will appeal and get paid and the other half will not even be aware and that is money in the pockets of insurance companies.

I did not know this but I wonder what punishments insurance company get for denying legit covered claims and services. They pay after we "appeal". To appeal cost PP extra cost, time and money. I let a lot of claims go because I don't have the staff or man power to appeal everything. So insurance companies make a lot of money from solo PP like me. But we are also the ones that commit fraud right.

Lastly I won't be surprised if the so called quality assurance organizations and insurance companies are in bed together because year after year nothing gets done except screwing the doctors.

I’m not going to keep addressing this since you have this conspiracy theory.

I am telling you there is NO conspiracy. There are no rules to deny because they know you are too busy to appeal.

They are not “in bed” with the quality assurance organizations, etc.

If you don’t have enough time or staff to appeal money owed to you, that’s an internal issue you need to remedy.

Again, I don’t get paid when consulted by telling them to deny things. I’ve recommended approval more than denial and explain my rationale. But it is difficult for them to always separate fraud from legit claims.

And I have never once seen a legit claim denied UNLESS there was some issue with documentation.

So stop all the conspiracy b.s. and see if there is a common denominator with your denials and remedy that issue.

I was consulted to be an unbiased party with a provider disputing ALL the surgical pre authorizations that were always being denied.

I was there as basically an arbitrator. This doctor was adamant it was a conspiracy to deny his surgical cases.

It took me all of two minutes to remedy the issue. Unknown to him, all his pre auth cases were being denied because his staff never sent records to review for pre auth. Obviously the doctor or nurse reviewing the case for pre auth needs to review records!!

His staff was lazy and never sent records. And when the cases were initially denied his staff WAS notified why the case was denied and they never told the provider.

If you are having that many cases that need appeal, there is some disconnect with you, your staff, your billing, your documentation or some or all of the above.

 

[DYK343]

Where is podiatry heading in 10 years? 5 years?

In the midst of the bull**** boards, what can practitioners expect in the future?

Multi specialty groups, supergroups , MSO’s , solo practices, hospital based employment (shudder) what’s the best structure to examined and prepare for the future of medicine

If I had a kid wanting to go DPM I would suggest against it. Too much of a financial risk.

I am very concerned podiatry will be oversaturated in 10 years. Weve seen it with optometry, pharmacy, law school, chiropractic, etc.

Opening two new schools is not good for the profession as there lacks a demand based on quality jobs available to new grads. This is going to get worse with increasing graudates. These kids are going to be 300k debt with very poor job prospects. The 80k a year salary is not a made up consipracy. Its real and a lot of people get stuck with those jobs.

Residency shortage is also very likely in near future unless these schools can somehow magically print new residencies (they cant/wont). When Western graduated their first class there was a 10% shortage of residencies for 3 years. 1 in 10 people simply got passed by with a huge debt to pay back. Ruined a lot of peoples lives as the next year there was also a shortage and the people who got passed by the first time got passed over the 2nd time too. Too many just had to walk away with that debt.

Had there not been two new approved schools I would say the future of podiatry is good. But I really cant recommend DPM school to anyone right now. Its a very risky investment from what I know and see happening.

Thats my opinion. Over the years I've been much more pro podiatry on here than the average poster. But my viewpoint is changing with the new schools. Its absolutely the wrong move IMO for the profession. I asked Lee Rogers, APMA president, in another thread to address the issues above and he has yet to respond. I assume because there is no logical answer to give. The risks are real and its just not a good financial situation to put oneself into right now.

 

[Feli]

...I am very concerned podiatry will be oversaturated in 10 years. Weve seen it with optometry, pharmacy, law school, chiropractic, etc.

Opening two new schools is not good for the profession as there lacks a demand based on quality jobs available to new grads. This is going to get worse with increasing graudates. These kids are going to be 300k debt with very poor job prospects...

..Residency shortage is also very likely in near future unless these schools can somehow magically print new residencies (they cant/wont). When Western graduated their first class there was a 10% shortage of residencies for 3 years. 1 in 10 people simply got passed by with a huge debt to pay back. Ruined a lot of peoples lives as the next year there was also a shortage and the people who got passed by the first time got passed over the 2nd time too. Too many just had to walk away with that debt...

... I asked Lee Rogers, APMA president, in another thread to address the issues above and he has yet to respond. I assume because there is no logical answer to give. The risks are real and its just not a good financial situation to put oneself into right now.

I will reply on APMA / AACPM unofficial and innacurate behalf:

"If you believe it, you can achieve it."

 

[NatCh]

I am consulted to review the good, the bad and the ugly. I go to bat for colleagues whenever possible.

Are you a consultant or… a consultain’t?

 

[GreenHousePub]

I am telling you there is NO conspiracy.

Huh. So I guess this conspiracy goes higher than I thought.....

 

[ExperiencedDPM]

Huh. So I guess this conspiracy goes higher than I thought.....

Yep, so until you get to the bottom of it you should stay in your bomb shelter with that gamma Ray protecting helmet.

 

[deleted1149159]

As @ExperiencedDPM said, denials are generally documentation related. The other side of the coin is coding. Some insurances have weird connecters between ICD-10 and CPT codes. And if you don't connect the two properly, it's denied. The one that stands out for me is for a Tibialis Anterior repair. Last I checked, there was no actual ICD-10 code for an Anterior Tibialis tendinitis or tear, like there is for PTT. You call it an extensor repair, but the too aren't connected in their system. So it's denied. Yes, appeals are a PITA, but that's just part of the game.

 

[deleted1149159]

Residency positions are a pendulum. Too many, then too few students, so some close, then uptick in students, for whatever reason, residency shortage. It's inevitable.

Ten years ago I got on my soapbox about this and urged the CPME to start considering one year programs again. For a few reasons. One, not everyone wants to be a surgeon. Two, not everyone should be a surgeon. Three, the majority of states (I think I wanna say 38, but I could be wrong) require at least one year of post graduate training to be eligible for a license to practice podiatry in.

Let me talk about three for a moment. I went on a tirade years ago with the APMA when there was a residency shortage, because the ones without, had to be very selective about what state they could practice in based on their lack of training. They didn't care. So I suggested they tell any incoming student, that it was possible that they would not be able to practice where they would want to if there was a residency shortage. The APMA wouldn't do that, of course. So I pushed the issue of starting one year programs again. The ABFAS, the ACFAS and the ASPS made a stink about this as this was "a step backwards" for the profession. I replied that not having people able to earn a living where they wanted to was a deathblow for the profession. So what happened? More residencies. And the pendulum started swinging that way. It will swing back within 5 years. Then what? This will be one of the topics of a blog I intend to write soon.

 

[DYK343]

Residency positions are a pendulum. Too many, then too few students, so some close, then uptick in students, for whatever reason, residency shortage. It's inevitable.

Ten years ago I got on my soapbox about this and urged the CPME to start considering one year programs again. For a few reasons. One, not everyone wants to be a surgeon. Two, not everyone should be a surgeon. Three, the majority of states (I think I wanna say 38, but I could be wrong) require at least one year of post graduate training to be eligible for a license to practice podiatry in.

Let me talk about three for a moment. I went on a tirade years ago with the APMA when there was a residency shortage, because the ones without, had to be very selective about what state they could practice in based on their lack of training. They didn't care. So I suggested they tell any incoming student, that it was possible that they would not be able to practice where they would want to if there was a residency shortage. The APMA wouldn't do that, of course. So I pushed the issue of starting one year programs again. The ABFAS, the ACFAS and the ASPS made a stink about this as this was "a step backwards" for the profession. I replied that not having people able to earn a living where they wanted to was a deathblow for the profession. So what happened? More residencies. And the pendulum started swinging that way. It will swing back within 5 years. Then what? This will be one of the topics of a blog I intend to write soon.

I agree there is always going to be a pendulum but were talking about different percentages of people not getting a residency with new schools opening.

When Western graduated about 50 students and created 3 residency training slots that is a guarenteed shortage. When Western graduated their class it resulted in ~10% for 3 years. Thats ~150 people that met the requirements to graduate but were failed upon by our profession. They had to walk away from the profession completely screwed.

We now have 2 new schools approved. I do not know the enrollment but google search LECOOM take about 530 DO students. If they try to take on 50-100 DPMs and the Texas school takes 50 or more its going to be a distaster. Even if they took a fraction of that its still going to be a major shortage.

I wax and wane on my opinion on 1 vs 2 vs 3 year programs. I like the idea of 1 vs 3 year trained but it does create confusion for other professions. What I ultimately think is we should downsize our graduating class size as is, up admission standards to "more than a pulse and a tuition check". and actually graduate high quality DPMs with top training. IMO that is what is best for the profession - but obviously will never happen as schools are a money machine and are not in it for the greater good.

 

[heybrother]

The problem with referring to the residency-school situation as a pendulum is that it somewhat suggests there's a natural flow of back and forth. In reality the reason this happens is because some for profit new school comes along and gets to make a profit without any consideration of the number of residency spots or the need for podiatrists. There will never be a situation where the balance was destroyed due to too many good residencies. It will always be the schools throwing things out of wack.

 

[deleted1149159]

I agree there is always going to be a pendulum but were talking about different percentages of people not getting a residency with new schools opening.

When Western graduated about 50 students and created 3 residency training slots that is a guarenteed shortage. When Western graduated their class it resulted in ~10% for 3 years. Thats ~150 people that met the requirements to graduate but were failed upon by our profession. They had to walk away from the profession completely screwed.

We now have 2 new schools approved. I do not know the enrollment but google search LECOOM take about 530 DO students. If they try to take on 50-100 DPMs and the Texas school takes 50 or more its going to be a distaster. Even if they took a fraction of that its still going to be a major shortage.

I wax and wane on my opinion on 1 vs 2 vs 3 year programs. I like the idea of 1 vs 3 year trained but it does create confusion for other professions. What I ultimately think is we should downsize our graduating class size as is, up admission standards to "more than a pulse and a tuition check". and actually graduate high quality DPMs with top training. IMO that is what is best for the profession - but obviously will never happen as schools are a money machine and are not in it for the greater good.

Brilliant synopsis.

I think that the one year positions would be for those that either can't get a surgical program, or don't want to. The confusion this will cause would be minimal, as the one year trained folks would likely never leave the comfort of a private practice office. They will also likely always be an employee of a bigger organization with other, lengthier trained DPMs. In an ideal scenario. Basically like a Physiatrist in an Ortho practice. Never sees the hospital or operating room patients. Helps with the PT department for rehab and such.

 

[dtrack22]

There are no rules to deny because they know you are too busy to appeal.

As @ExperiencedDPM said, denials are generally documentation related.

I would like to introduce you two to my friend Humana…

 

[ExperiencedDPM]

I would like to introduce you two to my friend Humana…

I know Humana better than most, so the introduction won’t be necessary. I personally was responsible in changing several of their national policies to make things much more user friendly for providers.

It’s a work in progress.

 

[ExperiencedDPM]

As @ExperiencedDPM said, denials are generally documentation related. The other side of the coin is coding. Some insurances have weird connecters between ICD-10 and CPT codes. And if you don't connect the two properly, it's denied. The one that stands out for me is for a Tibialis Anterior repair. Last I checked, there was no actual ICD-10 code for an Anterior Tibialis tendinitis or tear, like there is for PTT. You call it an extensor repair, but the too aren't connected in their system. So it's denied. Yes, appeals are a PITA, but that's just part of the game.

Appeals don’t need to be a PITA. You just have to know how to navigate the system and have the right person taking care of the appeal. There’s a right way and wrong way to appeal. One day I can and will likely publish on this issue.

I can teach you more in 2 hours than the “well known” national lecturer or courses. I know information that very few would be privy to in our profession.

 

[Pronation]

Brilliant synopsis.

I think that the one year positions would be for those that either can't get a surgical program, or don't want to. The confusion this will cause would be minimal, as the one year trained folks would likely never leave the comfort of a private practice office. They will also likely always be an employee of a bigger organization with other, lengthier trained DPMs. In an ideal scenario. Basically like a Physiatrist in an Ortho practice. Never sees the hospital or operating room patients. Helps with the PT department for rehab and such.

Graduate them from 1 year programs and call them chiropodists so there’s no confusion.

 

[dtrack22]

I know Humana better than most

Then you know that Humana absolutely has denied office based claims which were contractually agreed upon, did not require any prior auth, and were coded/billed correctly.

Thank god Humana doesn’t exist in the PNW.

 

[ExperiencedDPM]

Then you know that Humana absolutely has denied office based claims which were contractually agreed upon, did not require any prior auth, and were coded/billed correctly.

Thank god Humana doesn’t exist in the PNW.

I have zero influence regarding any office based claims. I am only consulted on 100% surgical claims. I do not get involved with imaging, office claims, DME, etc. I only consult on surgery.

 

[heybrother]

Humana is the king of denying office procedures. United is the king of denying surgeries.

 

[ExperiencedDPM]

Humana is the king of denying office procedures. United is the king of denying surgeries.

Surgical pre auth denials or post procedure denials. I can provide reasons for both and solutions to both.

 

[dtrack22]

I have zero influence regarding any office based claims. I am only consulted on 100% surgical claims. I do not get involved with imaging, office claims, DME, etc. I only consult on surgery.

This doesn’t change the fact that Humana has routinely denied appropriately coded/billed claims that they are contractually obligated to pay.

 

[heybrother]

Surgical pre auth denials or post procedure denials. I can provide reasons for both and solutions to both.

I don't disagree with you that most people have documentation errors. I routinely find my office manager spinning her wheels on claims by my partner where the surgical note from the center was never submitted (so what can the insurer even do), the codes are wrong too, and the limited documentation provided doesn't support the coding.

For United, we literally make prior authorization phone calls, get told no prior authorization is necessary, document and record names / log numbers etc and then still get told after the fact that prior authorization was necessary and that the procedure is denied even though we clearly made the phonecall, have proof of the phonecall, and correctly sough the authorization.

I dropped Humana last year/beginning of this year. My United contract can be terminated with 90 days notice before the anniversary which is coming up in April of 2024. I'm very excited about next year.

Thanks for the offer though. If BCBS starts defrauding I'll let you know!

 

[Boba Foot]

It's weird seeing one guy stick up for insurance companies so much.

 

[AttackNME]

So I pushed the issue of starting one year programs again. The ABFAS, the ACFAS and the ASPS made a stink about this as this was "a step backwards" for the profession.

One year programs would be great for us. If we can make a podiatry school with CPME unable to say no, what rules do they have that stops 1 year programs?

 

[msion]

I don't disagree with you that most people have documentation errors. I routinely find my office manager spinning her wheels on claims by my partner where the surgical note from the center was never submitted (so what can the insurer even do), the codes are wrong too, and the limited documentation provided doesn't support the coding.

For United, we literally make prior authorization phone calls, get told no prior authorization is necessary, document and record names / log numbers etc and then still get told after the fact that prior authorization was necessary and that the procedure is denied even though we clearly made the phonecall, have proof of the phonecall, and correctly sough the authorization.

Amen to this. United is such a pain. I once had a new patient wanting some custom orthosis. I told her it's probably not necessary and United won't cover them anyway. She then sat in the waiting room and called United. The rep on the other end said oh yeah, no auth needed, doc go ahead.
Fast forward 2 months later, claims were denied. Appealed and won. Reimbursed me $96 for "in-network rate". Didn't even cover my cost.
That's not even the best part. 6 months later patient came back asking for another pair. Told her no. Then she said she would pay me $96 cuz that's what United paid and supposedly I was still making a profit. Told her to GTFO.

 

[ExperiencedDPM]

It's weird seeing one guy stick up for insurance companies so much.

You’re clueless. I don’t “stick up” tor insurance companies. I tell the truth because I know the truth.

People make baseless assumptions and want to spew inaccuracies. Instead, I’m telling you that if you’re not getting paid, you may want to do some self reflecting.

My significant experience has shown that there are a lot of myths. Insurance is a business and they protect their assets. They may not make getting paid “easy” but I know of no company I’ve worked with that has secret policies not to pay.

Instead, it’s often crappy documentation or simply lack of documentation. But it’s much easier to blame the other guy.

I’ve been very successful and have always made it a point to be fully educated in every endeavor I enter. And I always self reflect to see if maybe I have some issue I can improve instead of lame excuses that default to the other guy or conspiracies.

The amount of fraud I’ve seen during my consults is astounding. It is constant and consistent.

So don’t point fingers of suspicion at me simply because I tell it as it is……

But go ahead and use the lame comeback “how do you know I was talking about you?”

 

[icebreaker32]

There are too many PP podiatrists doing scammy things and coding wrong.....most often intentionally. This is a fact.

Humana is horrible for providers. This is a fact. Many patients love Humana for all they give them and their nurses that call or visit them. Patients only hate Humana when all their doctors stop taking it, but most large groups and hospitals do take it who now employee most of the doctors. They are growing and might be a good stock to own. They might not put up with scammy coding, but they don't like legitimate coding either.

There are other plans that pay horrible and require lots of pre auth not only for surgeries, but for things like injections and give short windows once you get the pre auth etc....but generally play by their rules. It is no fun, but that is what you get with many HMOs.

My time in PP nothing came close to Humana. They are next level bad. Modifiers mean nothing to them for legitimate reasons to be paid. Appeals often mean little also. Getting DME approved in the office is a hassle. They request copies of patient records more than any other insurance company for frequent “random” audits....never had a complaint or problem after submitting records, but it was a burden on staff.

 

[Pronation]

There are too many PP podiatrists doing scammy things and coding wrong.....most often intentionally. This is a fact.

Humana is horrible for providers. This is a fact. Many patients love Humana for all they give them and their nurses that call or visit them. Patients only hate Humana when all their doctors stop taking it, but most large groups and hospitals do take it who now employee most of the doctors. They are growing and might be a good stock to own. They might not put up with scammy coding, but they don't like legitimate coding either.

There are other plans that pay horrible and require lots of pre auth not only for surgeries, but for things like injections and give short windows once you get the pre auth etc....but generally play by their rules. It is no fun, but that is what you get with many HMOs.

My time in PP nothing came close to Humana. They are next level bad. Modifiers mean nothing to them for legitimate reasons to be paid. Appeals often mean little also. Getting DME approved in the office is a hassle. They request copies of patient records more than any other insurance company for frequent “random” audits....never had a complaint or problem after submitting records, but it was a burden on staff.

Indeed. It has become obvious that some of extraneous and exorbitant documentation that they now require is not just to prevent fraud but also to discourage providers from billing it. Lame

 

[air bud]

You know who isn't chiming in on this discussion? People on a RVU model...

 

[wakaflocka88]

You know who isn't chiming in on this discussion? People on a RVU model...

I can never go back to PP. The freedom was great but dealing with insurance headaches was another story. I value my life and sanity and podiatry is just a job for me. I do not live for podiatry nor will I let it interfere with my family time.

 

[heybrother]

You know who isn't chiming in on this discussion? People on a RVU model...

There's still plenty for hospital employed people to hate. People with Medicare Advantage plans are often difficult to place into skilled care after discharge because MA plans won't pay for anything. Maybe that's just the hospitalist / care coordination's problem but at my residency it was my problem.

 

[Pronation]

There's still plenty for hospital employed people to hate. People with Medicare Advantage plans are often difficult to place into skilled care after discharge because MA plans won't pay for anything. Maybe that's just the hospitalist / care coordination's problem but at my residency it was my problem.

Couldn’t care less about this as an attending. It’s very rare that we get stuck with these patients under our service. They get admitted under the hospitalist service and then get signed off and then reconsulted in X weeks if still inpatient for what would have been their next visit.

 

[heybrother]

The patient has Medicare + a secondary. They get discharged to a skilled facility with nursing care. They are less likely to walk on their non-surgical foot / screw it up. They do well at follow-up and hopefully heal without complication.

And here comes a strawman argument.

The patient has a Medicare Advantage plan. The simple truth is this often indicates that they have less money to begin with otherwise they'd have just paid for a secondary. They can't be placed. They go home, walk on the foot, and end up taking care of some other family member who is just as poorly off as they are. They show up at follow-up and are dehisced and deteriorated. You write in the chart that they are non-compliant and start debriding or amputating more or they get a BKA. Why are these patients so ridiculous and non-compliant you tell the other doctors.

Everyone will have their own level of interest in these patients. Maybe its just work. Maybe a dehisced patient is the same as a healing patient - just another person to get through the day with. Maybe it never would have made a difference to begin with. The issue though is that the behind the scenes can often have a lot to do with what happens next. We can't control what patients do. We can't pay for or pick their insurance for them. But if you find yourself sometimes wondering - why does it sometimes work and why sometimes does everything fall apart. Sometimes something as boring / trivial as - the patient had insurance to pay for skilled nursing could be the difference. MA sucks.

 

[Pronation]

The patient has Medicare + a secondary. They get discharged to a skilled facility with nursing care. They are less likely to walk on their non-surgical foot / screw it up. They do well at follow-up and hopefully heal without complication.

And here comes a strawman argument.

The patient has a Medicare Advantage plan. The simple truth is this often indicates that they have less money to begin with otherwise they'd have just paid for a secondary. They can't be placed. They go home, walk on the foot, and end up taking care of some other family member who is just as poorly off as they are. They show up at follow-up and are dehisced and deteriorated. You write in the chart that they are non-compliant and start debriding or amputating more or they get a BKA. Why are these patients so ridiculous and non-compliant you tell the other doctors.

Everyone will have their own level of interest in these patients. Maybe its just work. Maybe a dehisced patient is the same as a healing patient - just another person to get through the day with. Maybe it never would have made a difference to begin with. The issue though is that the behind the scenes can often have a lot to do with what happens next. We can't control what patients do. We can't pay for or pick their insurance for them. But if you find yourself sometimes wondering - why does it sometimes work and why sometimes does everything fall apart. Sometimes something as boring / trivial as - the patient had insurance to pay for skilled nursing could be the difference. MA sucks.

Indeed and agree. Unfortunately this just comes with the territory. I’m not saying to entirely turn a blind eye to it, but you also can’t let it eat you up.

 

[619]

For United, we literally make prior authorization phone calls, get told no prior authorization is necessary, document and record names / log numbers etc and then still get told after the fact that prior authorization was necessary and that the procedure is denied even though we clearly made the phonecall, have proof of the phonecall, and correctly sough the authorization.

I dropped Humana last year/beginning of this year. My United contract can be terminated with 90 days notice before the anniversary which is coming up in April of 2024. I'm very excited about next year.

Amen to this. United is such a pain. I once had a new patient wanting some custom orthosis. I told her it's probably not necessary and United won't cover them anyway. She then sat in the waiting room and called United. The rep on the other end said oh yeah, no auth needed, doc go ahead.
Fast forward 2 months later, claims were denied. Appealed and won. Reimbursed me $96 for "in-network rate". Didn't even cover my cost.
That's not even the best part. 6 months later patient came back asking for another pair. Told her no. Then she said she would pay me $96 cuz that's what United paid and supposedly I was still making a profit. Told her to GTFO.

Someone here said y'all should stop complaining and just hire more staff "to appeal money owed to you" and that will automatically solve the issue. Apparently "that’s an internal issue". Same person is getting paid big bucks by insurance companies to screw fellow colleagues over and "catch fraud". But then who is the catching the fraud committed by insurance companies daily? Oh some quality assurance organizations are policing the insurance companies. Complete BS and nonsense!!!!

How can you tell someone no prior authorization is needed and then turn around and deny the claim. But sure go ahead and defend the insurance companies.

Insurance companies routinely deny office visits or procedures without even asking for notes or documentations. This is a perfectly entered claim. After we appeal and send notes, then it gets paid. Someone explain the logic other than I should just hire more staff and it's an internal issue. I don't see what is internal there. All my appealed claims get paid but then it gets tiring. Why I can't I just simply get paid for services rendered? Few commit fraud doesn't mean ALL commit fraud. For example Medicare re-imbursement for diabetic nailcare is like 40 bucks. Waste of time or staff time appealing that if claim gets denied.

 

[deleted1149159]

One year programs would be great for us. If we can make a podiatry school with CPME unable to say no, what rules do they have that stops 1 year programs?

Mostly because you have to get a hospital to agree to foot the bill for the first year of the program. And if these residents aren't going to be in the hospital much, there is no financial advantage to the institution to do this.

 

[deleted1149159]

Appeals don’t need to be a PITA. You just have to know how to navigate the system and have the right person taking care of the appeal. There’s a right way and wrong way to appeal. One day I can and will likely publish on this issue.

I can teach you more in 2 hours than the “well known” national lecturer or courses. I know information that very few would be privy to in our profession.

Absolutely correct. The issue is having staff, or your billing warehouse to keep on top of it. And yes, you need the right person to do this for a practice, which is difficult to find. And someone who is honest about the work and won't rip you off. That's really the PITA part, LOL.

 

[deleted1149159]

Someone here said y'all should stop complaining and just hire more staff "to appeal money owed to you" and that will automatically solve the issue. Apparently "that’s an internal issue". Same person is getting paid big bucks by insurance companies to screw fellow colleagues over and "catch fraud". But then who is the catching the fraud committed by insurance companies daily? Oh some quality assurance organizations are policing the insurance companies. Complete BS and nonsense!!!!

How can you tell someone no prior authorization is needed and then turn around and deny the claim. But sure go ahead and defend the insurance companies.

Insurance companies routinely deny office visits or procedures without even asking for notes or documentations. This is a perfectly entered claim. After we appeal and send notes, then it gets paid. Someone explain the logic other than I should just hire more staff and it's an internal issue. I don't see what is internal there. All my appealed claims get paid but then it gets tiring. Why I can't I just simply get paid for services rendered? Few commit fraud doesn't mean ALL commit fraud. For example Medicare re-imbursement for diabetic nailcare is like 40 bucks. Waste of time or staff time appealing that if claim gets denied.

I'm with @ExperiencedDPM on this one. So many claims get sent in incorrectly, which is why "the system" just spits it out as a denial. A number missing, a number in the wrong place, someone not paying attention and billing one patient while entering the number for another. Incorrect ICD-10 numbers. The list goes on and on.

Here's a very simple one. You give an injection to the right heel and code M72.2. Your ICD-10 code isn't sided. Neither is your CPT code. Some people think all they need to do is put M72.2, without the associated pain code M79.671. So they do 10 injections in a week, and every single one of them is denied. Or they put M79.672, which is for left foot pain, but say they gave an injection to the right foot. Imagine if people do this for every sided procedure they do? As I said, the list goes on and on. And sorry, but that has nothing to do with insurance companies. That has to do with entitled physicians who don't know what they're doing, coding wise. "GIVE ME MAH MONEY!!"

And btw, where are young doctors supposed to learn this? From older doctors who haven't a clue? From coding seminars taught by people who haven't been in private practice for 20 years?

 

[ExperiencedDPM]

Someone here said y'all should stop complaining and just hire more staff "to appeal money owed to you" and that will automatically solve the issue. Apparently "that’s an internal issue". Same person is getting paid big bucks by insurance companies to screw fellow colleagues over and "catch fraud". But then who is the catching the fraud committed by insurance companies daily? Oh some quality assurance organizations are policing the insurance companies. Complete BS and nonsense!!!!

How can you tell someone no prior authorization is needed and then turn around and deny the claim. But sure go ahead and defend the insurance companies.

Insurance companies routinely deny office visits or procedures without even asking for notes or documentations. This is a perfectly entered claim. After we appeal and send notes, then it gets paid. Someone explain the logic other than I should just hire more staff and it's an internal issue. I don't see what is internal there. All my appealed claims get paid but then it gets tiring. Why I can't I just simply get paid for services rendered? Few commit fraud doesn't mean ALL commit fraud. For example Medicare re-imbursement for diabetic nailcare is like 40 bucks. Waste of time or staff time appealing that if claim gets denied.

You simply don’t “get it”. Not sure I ever told anyone to hire more staff to fight appeals. You just have to hire the RIGHT staff who understand coding and billing and the process.

How many DPM practices employ a certified coder?

And you make the *****ic comment that “the same person is getting paid the big bucks to screw fellow colleagues over and catch fraud”.

I have never and will never ״screw colleagues”. Last year alone I turned away about $230,000 worth of legal work because I will not take a case against a peer.

Those who commit fraud screw YOU, the insurers and themselves. I don’t have to screw them, they have already done that by committing fraud.

I don’t “hunt” for fraud. I’m called in to confirm or deny fraud. When a provider bills ORIF of a talo talar dislocation 45 times a year, they ask me to review the records. I read the op report and see that the provider did an arthroereisis and tell them he didn’t perform an ORIF. I’m not on a witch hunt.

Are you that simple minded that you don’t realize that fraud is the thorn in YOUR side? It’s costing us all money and more scrutiny.

And I’ve defended hundreds of peers to try to explain their “creative” billing. And it’s because of ME and ME alone that several national surgical policies/criteria were changed for a few of the largest insurers on earth. And those changes REDUCED the criteria needed for pre authorization approval.

So don’t take your anger regarding your woes on me. You have NO idea how much I’ve done to help providers, decrease outdated policies and criteria AND offer my services to colleagues gratis.

I have lectured to practices and have consulted on issues and have never ONCE taken a penny.

What have you done for the profession other than whine?

 

[heybrother]

I'm with @ExperiencedDPM on this one. So many claims get sent in incorrectly, which is why "the system" just spits it out as a denial. A number missing, a number in the wrong place, someone not paying attention and billing one patient while entering the number for another. Incorrect ICD-10 numbers. The list goes on and on.

Here's a very simple one. You give an injection to the right heel and code M72.2. Your ICD-10 code isn't sided. Neither is your CPT code. Some people think all they need to do is put M72.2, without the associated pain code M79.671. So they do 10 injections in a week, and every single one of them is denied. Or they put M79.672, which is for left foot pain, but say they gave an injection to the right foot. Imagine if people do this for every sided procedure they do? As I said, the list goes on and on. And sorry, but that has nothing to do with insurance companies. That has to do with entitled physicians who don't know what they're doing, coding wise. "GIVE ME MAH MONEY!!"

And btw, where are young doctors supposed to learn this? From older doctors who haven't a clue? From coding seminars taught by people who haven't been in private practice for 20 years?

I get what you are saying, but unfortunately your example is not the case anywhere I've practiced. I do not list pain - ever. I get paid for procedures in general without complication. If you had to list pain to get paid for plantar fasciitis it would be all over APMA coding courses. Additionally, we would all just build "pain" into our order sets so everytime I entered PF as a diagnosis it would be entered with pain also. I routinely read PM news where people talk about this but where I practice and where I trained - it was not the case.

Maybe this is the case on the east coast or somewhere that people have to attend podiatry billing secret courses.

 

[Pronation]

You simply don’t “get it”. Not sure I ever told anyone to hire more staff to fight appeals. You just have to hire the RIGHT staff who understand coding and billing and the process.

How many DPM practices employ a certified coder?

And you make the *****ic comment that “the same person is getting paid the big bucks to screw fellow colleagues over and catch fraud”.

I have never and will never ״screw colleagues”. Last year alone I turned away about $230,000 worth of legal work because I will not take a case against a peer.

Those who commit fraud screw YOU, the insurers and themselves. I don’t have to screw them, they have already done that by committing fraud.

I don’t “hunt” for fraud. I’m called in to confirm or deny fraud. When a provider bills ORIF of a talo talar dislocation 45 times a year, they ask me to review the records. I read the op report and see that the provider did an arthroereisis and tell them he didn’t perform an ORIF. I’m not on a witch hunt.

Are you that simple minded that you don’t realize that fraud is the thorn in YOUR side? It’s costing us all money and more scrutiny.

And I’ve defended hundreds of peers to try to explain their “creative” billing. And it’s because of ME and ME alone that several national surgical policies/criteria were changed for a few of the largest insurers on earth. And those changes REDUCED the criteria needed for pre authorization approval.

So don’t take your anger regarding your woes on me. You have NO idea how much I’ve done to help providers, decrease outdated policies and criteria AND offer my services to colleagues gratis.

I have lectured to practices and have consulted on issues and have never ONCE taken a penny.

What have you done for the profession other than whine?

The main takeaway that I got from your post is that I can make an easy $230k throwing others under the bus?

Can you give me some more info on where I can sign up? Thanks in advance

 

[ExperiencedDPM]

The main takeaway that I got from your post is that I can make an easy $230k throwing others under the bus?

Can you give me some more info on where I can sign up? Thanks in advance

Yes, just call 1-800-11NatCH

 

[Feli]

The problem with referring to the residency-school situation as a pendulum is that it somewhat suggests there's a natural flow of back and forth. In reality the reason this happens is because some for profit new school comes along and gets to make a profit without any consideration of the number of residency spots or the need for podiatrists. There will never be a situation where the balance was destroyed due to too many good residencies. It will always be the schools throwing things out of wack.

Correct.

The "pendulum" is a myth. It's greed and crap to churn out more grads than quality programs and create a residency shortage. This has never happened and will never happen to USA MD grads... and it never will. They have always had a surplus of high quality MD resident accredited spots across specialties and controlled MD school openings based on such. They do it so well so that they continually even incorporate many DOs and FMGs into the less popular USA MD hospital resident spots (even though they have zero obligation to do so).

Residency positions are a pendulum. Too many, then too few students, so some close, then uptick in students, for whatever reason, residency shortage. It's inevitable..
...

BS.
This is a horrible post and needs to be called out. Any "pendulum" is purely a podiatry schools' greedy creation.

Don't believe that junk that it's logical to have people spend hundreds of thousands on a professional degree program to have no training available - some of whom have even passed all student/national boards.

Do believe the new schools will create a shortage. Even if dozens and dozens of residency spots are miraculously created to match the additional graduates, they largely won't be quality spots. We saw this when all programs became 3yr and many VA programs and others were hastily created whether they had enough surgery and attendings and allied med/surg rotations and research support or not. Again, things that would virtually never happen with USA MD programs, which are largely at teaching and univ hospitals and actually legitimately checked to ensure adequate volume and resident exp and competency.

Podiatry has hundreds of present day residency spots which could be closed down, consolidated to increase volume, or only filled in years with very high numbers of grads. That would be in a fantasy land where we actually care about quality of training, though. That is a the HUUUGE risk with with pursuing a DPM degree and always has been: even if you work hard, get grades, pass boards... there are still only a finite amount of truly high quality residency spots. The discussions on here about which few those are are likely SDN Podiatry's most important info. It is no small wonder why alumni of most quality programs prefer to network and hire their own or grads of other name programs. The board pass rates and compensation studies speak for themselves.

The new schools will recklessly compound things (yet again). A program has to go unfilled year after year or have serious quality issues and resident and site visit complaints to be on probation or lose accreditation. That QC won't be happening with a shortage upcoming; we will be back to CPME pushing on good and average programs to add spots and dilute training... and having poor and average quality programs hastily created or renewed when they should be scrutinized for low quality/volume. There is no pendulum.

 

[deleted1149159]

Correct.

The "pendulum" is a myth. It's greed and crap to churn out more grads than quality programs and create a residency shortage. This has never happened and will never happen to USA MD grads... and it never will. They have always had a surplus of high quality MD resident accredited spots across specialties and controlled MD school openings based on such. They do it so well so that they continually even incorporate many DOs and FMGs into the less popular USA MD hospital resident spots (even though they have zero obligation to do so).


BS.
This is a horrible post and needs to be called out. Any "pendulum" is purely a podiatry schools' greedy creation.

Don't believe that junk that it's logical to have people spend hundreds of thousands on a professional degree program to have no training available - some of whom have even passed all student/national boards.

Do believe the new schools will create a shortage. Even if dozens and dozens of residency spots are miraculously created to match the additional graduates, they largely won't be quality spots. We saw this when all programs became 3yr and many VA programs and others were hastily created whether they had enough surgery and attendings and allied med/surg rotations and research support or not. Again, things that would virtually never happen with USA MD programs, which are largely at teaching and univ hospitals and actually legitimately checked to ensure adequate volume and resident exp and competency.

Podiatry has hundreds of present day residency spots which could be closed down, consolidated to increase volume, or only filled in years with very high numbers of grads. That would be in a fantasy land where we actually care about quality of training, though. That is a the HUUUGE risk with with pursuing a DPM degree and always has been: even if you work hard, get grades, pass boards... there are still only a finite amount of truly high quality residency spots. The discussions on here about which few those are are likely SDN Podiatry's most important info. It is no small wonder why alumni of most quality programs prefer to network and hire their own or grads of other name programs. The board pass rates and compensation studies speak for themselves.

The new schools will recklessly compound things (yet again). A program has to go unfilled year after year or have serious quality issues and resident and site visit complaints to be on probation or lose accreditation. That QC won't be happening with a shortage upcoming; we will be back to CPME pushing on good and average programs to add spots and dilute training... and having poor and average quality programs hastily created or renewed when they should be scrutinized for low quality/volume. There is no pendulum.

I wrote out this long response and deleted it. Mostly because the only thing to say about the above diatribe is "LOL".

 

[DYK343]

IMO there is a small pendulum but it is the existing schools taking 10% more (or whatever they estimate) will drop out and they may be occasionally wrong. Almost like an airplane overbooking seats. Also residency programs close and new ones pop up. When were running right at efficiency - maybe 550 grads for 575 spots this can get tricky with such a small profession.

MD schools have a huge surplus of spots - correct. But they have a buffer DPM doesnt. Foreign medical grads. They can create almost as many residencies as they want. US students fill many of the slots then they add FMGs to the mix to fill the remainder of the slots.

Creating 2 schools is a terrible idea. We cant absorb it in any way shape or form. Beginning to end anyway you look at it its awful for the profession. Just absolutely stupid.

 

[619]

You simply don’t “get it”. Not sure I ever told anyone to hire more staff to fight appeals. You just have to hire the RIGHT staff who understand coding and billing and the process.

How many DPM practices employ a certified coder?

And you make the *****ic comment that “the same person is getting paid the big bucks to screw fellow colleagues over and catch fraud”.

I have never and will never ״screw colleagues”. Last year alone I turned away about $230,000 worth of legal work because I will not ta

Last year alone I turned away about $230,000 worth of legal work because I will not take a case against a peer.

If anyone believes this statement then I have a bridge to sell you.

ke a case against a peer.

Those who commit fraud screw YOU, the insurers and themselves. I don’t have to screw them, they have already done that by committing fraud.

I don’t “hunt” for fraud. I’m called in to confirm or deny fraud. When a provider bills ORIF of a talo talar dislocation 45 times a year, they ask me to review the records. I read the op report and see that the provider did an arthroereisis and tell them he didn’t perform an ORIF. I’m not on a witch hunt.

Are you that simple minded that you don’t realize that fraud is the thorn in YOUR side? It’s costing us all money and more scrutiny.

And I’ve defended hundreds of peers to try to explain their “creative” billing. And it’s because of ME and ME alone that several national surgical policies/criteria were changed for a few of the largest insurers on earth. And those changes REDUCED the criteria needed for pre authorization approval.

So don’t take your anger regarding your woes on me. You have NO idea how much I’ve done to help providers, decrease outdated policies and criteria AND offer my services to colleagues gratis.

I have lectured to practices and have consulted on issues and have never ONCE taken a penny.

What have you done for the profession other than whine?

I will rather do nothing for the profession rather than make "big bucks from insurance companies" and "catch fraud"

 

[619]

Here's a very simple one. You give an injection to the right heel and code M72.2. Your ICD-10 code isn't sided. Neither is your CPT code. Some people think all they need to do is put M72.2, without the associated pain code M79.671. So they do 10 injections in a week, and every single one of them is denied. Or they put M79.672, which is for left foot pain, but say they gave an injection to the right foot. Imagine if people do this for every sided procedure they do? As I said, the list goes on and on. And sorry, but that has nothing to do with insurance companies. That has to do with entitled physicians who don't know what they're doing, coding wise. "GIVE ME MAH MONEY!!"

This is a very obvious example that can be easily fixed. No one is talking about claims being denied for errors made in laterality. No one is complaining about claims getting denied for bad documentation or incorrect notes. Those claims should be denied and I 100% agree.

You are not commenting on the situation of getting prior-authorization approved and still getting the same claim denied. Everyone seems to skip this part and just complain of fraud fraud fraud.

 

[ExperiencedDPM]

The main takeaway that I got from your post is that I can make an easy $230k throwing others under the bus?

Can you give me some more info on where I can sign up? Thanks i

If anyone believes this statement then I have a bridge to sell you.


I will rather do nothing for the profession rather than make "big bucks from insurance companies" and "catch fraud"

There is something seriously wrong with you. You question my integrity and question my honesty.

I can back up everything I wrote and if you want to put your money where your mouth is I can prove it. Unlike your baseless insults.

I don’t know why you keep defending fraud. And I don’t know why you keep defaulting to me “catching fraud”. I am consulted to read an operative report and let them know what was performed. I’m asked how the procedure should be billed and I supply that information. They then show me the codes that were billed and ask me if it’s appropriate. If there is any way I can justify the billing I will always side with the provider. But blatant fraud speaks for itself.

Do you not understand that fraud is what drives these pre authorizations and red tape?

Sorry that you are apparently an unsuccessful practitioner. But I assure you (and I’m willing to put money up) that I have changed and created national policies for several companies (and received no money for those changes) and each one of those changes decreased the difficulty of getting certain procedures approved.

They don’t pay for that type of input, but I am well known to these companies and when they solicit my review of policies I’m happy to oblige, because it helps my colleagues and my own practice. Because my practice isn’t immune from pre authorizations, delayed payments and red tape.

Start blaming the right people. I assure you I am NOT part of the problem. And if you choose not to believe me, that’s truly YOUR problem.

 

[Shiyuan]

There is something seriously wrong with you. You question my integrity and question my honesty.

I can back up everything I wrote and if you want to put your money where your mouth is I can prove it. Unlike your baseless insults.

I don’t know why you keep defending fraud. And I don’t know why you keep defaulting to me “catching fraud”. I am consulted to read an operative report and let them know what was performed. I’m asked how the procedure should be billed and I supply that information. They then show me the codes that were billed and ask me if it’s appropriate. If there is any way I can justify the billing I will always side with the provider. But blatant fraud speaks for itself.

Do you not understand that fraud is what drives these pre authorizations and red tape?

Sorry that you are apparently an unsuccessful practitioner. But I assure you (and I’m willing to put money up) that I have changed and created national policies for several companies (and received no money for those changes) and each one of those changes decreased the difficulty of getting certain procedures approved.

They don’t pay for that type of input, but I am well known to these companies and when they solicit my review of policies I’m happy to oblige, because it helps my colleagues and my own practice. Because my practice isn’t immune from pre authorizations, delayed payments and red tape.

Start blaming the right people. I assure you I am NOT part of the problem. And if you choose not to believe me, that’s truly YOUR problem.

Hey y’all, someone’s gotta do the job... i’d rather it be someone with integrity versus some grandfathered ABFAS person who salivates over opportunities to make other pod’s lives miserable 🤷🏻‍♂️

 

[AttackNME]

There is something seriously wrong with you. You question my integrity and question my honesty.

I can back up everything I wrote and if you want to put your money where your mouth is I can prove it. Unlike your baseless insults.

I don’t know why you keep defending fraud. And I don’t know why you keep defaulting to me “catching fraud”. I am consulted to read an operative report and let them know what was performed. I’m asked how the procedure should be billed and I supply that information. They then show me the codes that were billed and ask me if it’s appropriate. If there is any way I can justify the billing I will always side with the provider. But blatant fraud speaks for itself.

Do you not understand that fraud is what drives these pre authorizations and red tape?

Sorry that you are apparently an unsuccessful practitioner. But I assure you (and I’m willing to put money up) that I have changed and created national policies for several companies (and received no money for those changes) and each one of those changes decreased the difficulty of getting certain procedures approved.

They don’t pay for that type of input, but I am well known to these companies and when they solicit my review of policies I’m happy to oblige, because it helps my colleagues and my own practice. Because my practice isn’t immune from pre authorizations, delayed payments and red tape.

Start blaming the right people. I assure you I am NOT part of the problem. And if you choose not to believe me, that’s truly YOUR problem.

Real billing and coding seminars and examples are what we need, as a podiatrist in PP I’ve been to seminars webinars conferences and asked the experts on apma coding resource but it’s all regurgitation of the definition of the CPT code and then ending their sentence with “this is my opinion”.