The future of podiatry

[thefootfixer]

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

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[Weirdy]

Speculation is speculation.

 

[Pronation]

You can expect to make $85k working in some crappy private practice office as the supply grossly exceeds demand from these new pod schools unnecessarily flooding the market with more pods. You might get lucky and get hospital based employment for 300k though (shudder), if they choose you out of 100+ other applicants.

 

[deleted1149159]

The future of medicine is hard to predict. Especially with how reimbursement is going. The population is aging, and I truly believe Podiatry will have a place in the medical landscape for a long time to come. That being said, how practice itself is evolving is anyone's guess. There will always be a place for the highly motivated private solo practitioners. Especially those that do "boutique" practices. If we all went that way, we would all benefit, truly. Also, I believe at a certain point we should unionize. First to have more negotiating power with insurances, but also to protect ourselves from being taken for a ride by our very own colleagues.

 

[diabeticfootdr]

“The best way to predict the future is to create it.” Peter Drucker

Be a part of the solution.

 

[heybrother]

Anyone who tells you they know the answer to this is making it up.

1. Podiatry applications are in a rough place. If they stay the same or decline further it feels like something has to happen though what it will be is another question. It seems like you wouldn't be able to maintain 500-600 residency spots if the schools consistently generate only 300 graduates.

2. Theoretically the Medicare trust fund is going to deplete in the years ahead. What will happen, how it will be addressed, the ramifications - I cannot say.

3. Supposedly, private equity is having a rough year in other medical fields because of the No Surprises Act ie. anesthesia, perhaps emergency medicine. We seem to be experiencing an opening salvo of this industry into podiatry though - podiatry seems less profitable than other industries ie. dermatology and therefore there opportunities may be different. How this will affect podiatry, supergroups backed by PE - I can't say. The underlying mission of private equity is to generate a revenue stream off of your works. In a field where its already difficult to enjoy your own profits and labors - we shall see.

4. Transparency acts passed under Trump and implemented over the last few years theoretically should expose bizarre underlying fundamentals in medicine ie. why does one insurance pay a hospital $4000 for an MRI and another pays $500. Assuming that actually puts any more money in your pocket or your patient's pocket is another thing.

5. Podiatry hospital money seems to be increasing...

6. My personal experience with insurance companies this past 2 years was mostly negative. In a small turn of events though I determined why BCBS was paying me more for surgery this past year. They are reimbursing providers at a higher rate if their cases are performed at an ASC. I saw the money coming in but didn't know why. Its on their website.

7. A small personal anecdote. I'm talking to another IPA. Still figuring things out but there is the possibility to increase a few of our contracts substantially. Strength in numbers perhaps.

8. Walking down the aisle at groceries stories where things are becoming progressively more expensive - its painful to consider that increasing prices in your podiatry practice will have no effect on your reimbursement in the majority of circumstances unless you generate a cash pay or out of network component.

9. Always be saving. Control costs.

 

[thefootfixer]

Anyone who tells you they know the answer to this is making it up.

1. Podiatry applications are in a rough place. If they stay the same or decline further it feels like something has to happen though what it will be is another question. It seems like you wouldn't be able to maintain 500-600 residency spots if the schools consistently generate only 300 graduates.

The new schools are definitely screwing up the markets

2. Theoretically the Medicare trust fund is going to deplete in the years ahead. What will happen, how it will be addressed, the ramifications - I cannot say.

3. Supposedly, private equity is having a rough year in other medical fields because of the No Surprises Act ie. anesthesia, perhaps emergency medicine. We seem to be experiencing an opening salvo of this industry into podiatry though - podiatry seems less profitable than other industries ie. dermatology and therefore there opportunities may be different. How this will affect podiatry, supergroups backed by PE - I can't say. The underlying mission of private equity is to generate a revenue stream off of your works. In a field where its already difficult to enjoy your own profits and labors - we shall see.

At some point PE companies have to say “ok we have enough pods”…it has to be capped at some point. If you don’t see to PE, then I guess sell to a hospital, or join and IPA/MSO

4. Transparency acts passed under Trump and implemented over the last few years theoretically should expose bizarre underlying fundamentals in medicine ie. why does one insurance pay a hospital $4000 for an MRI and another pays $500. Assuming that actually puts any more money in your pocket or your patient's pocket is another thing.

5. Podiatry hospital money seems to be increasing...

6. My personal experience with insurance companies this past 2 years was mostly negative. In a small turn of events though I determined why BCBS was paying me more for surgery this past year. They are reimbursing providers at a higher rate if their cases are performed at an ASC. I saw the money coming in but didn't know why. Its on their website.

7. A small personal anecdote. I'm talking to another IPA. Still figuring things out but there is the possibility to increase a few of our contracts substantially. Strength in numbers perhaps.

I guess this is where a “group practice” would make sense..

8. Walking down the aisle at groceries stories where things are becoming progressively more expensive - its painful to consider that increasing prices in your podiatry practice will have no effect on your reimbursement in the majority of circumstances unless you generate a cash pay or out of network component.

9. Always be saving. Control costs.

 

[thefootfixer]

“The best way to predict the future is to create it.” Peter Drucker

Be a part of the solution.

Understood.

But what’s the solution?

 

[wakaflocka88]

“The best way to predict the future is to create it.” Peter Drucker

Be a part of the solution.

Can’t create when the overwhelming majority of jobs currently pay less than $100k upfront.

 

[diabeticfootdr]

Can’t create when the overwhelming majority of jobs currently pay less than $100k upfront.

Are you an American or an American’t?

 

[icebreaker32]

Not to be a jerk, but most threads tell one how to make the most of an honestly bad job market.

People considering podiatry should think long and hard, but those beyond their first year in school it is best to stay and be proactive.

1. Be geographically open for the best residency

2. Be geographically open for the best job Midwest is often your best chance for living in a city larger than 60,000. Use any hometown connection you have for hospital, Ortho, MSG jobs and stay in touch with hometown podiatrists during school and residency.

3. Have the mindset before residency you might need to open up your own office eventually. Try to learn what you can about private practice in residency and have mentors. A couple years of private practice experience before opening an office really helps.....unless you are just doing nursing homes and working Medi/Medi clinics.

4. If you are in a saturated area and can not move for family reasons you might have to leave one bad job for another slightly better bad job just beyond the no compete radius. At some point you will have to take the gamble to open up an office and probably do things a bit more scammy than you thought to pay the bills.

5. If there is an undeserved area not too far away from where you must live (there often are), could you move at least an hour or two away from family? If no podiatrists are employed by hospitals in the underserved area try to create your own hospital job. If they will not hire you, see if they can at least assist you....maybe waive you your lease for a year in their office space and market for you if you move there. Any help will still be taxed as income if not employed other than maybe marketing.

You can keep working the associate job and pray a hospital or VA job opens up close to where you live.....but you need to stand out or have connections to have a good chance. Make sure your CV looks good. Take leadership positions (one reason to join APMA, but you can also be active with hospital, medical societies, charities etc)!and make sure you get board certified by ABFAS, preferably RRA. You will also be a better applicant for jobs further away if you decide you can move away from family later. Delay buying a house and a new car.....easier to move for a better job and save money to open your own practice

There are not enough good jobs in this profession. The only way to fix this is cut supply.

There are probably enough opportunities to open offices outside of the most saturated areas and do very scammy things to do better than being an associate.

6. You could can go in a time machine and go back in time. Choose a different profession where there are jobs everywhere with signing bonuses, relocation assistance and student loan assistance/forgiveness.

 

[ExperiencedDPM]

Are you an American or an American’t?

Come on, you’re better than cliches.

 

[NatCh]

Come on, you’re better than cliches.

I chuckled...

 

[air bud]

Speculation is speculation.

In case you didn't know wild speculation always has a happy ending.

 

[DYK343]

Are you an American or an American’t?

When traveling abroad and in a group they always ask "where are you from"
One group might say England
One group might say South Africa
One group from Ohio might say United States
Texans always say "Texas" lol

 

[Pronation]

I heard that only steers and cheers come from Texas

 

[NatCh]

Are you a Texan or a Texan't?

 

[heybrother]

I grew up loving San Marcos, New Braunfels, Devil's Backbone, etc. Never really got Austin though I did spend some time on lakes around it. Am looking for a spot on the calendar for Big Bend next year. That said, whenever I visit places like Colorado or Oregon I'm like... wait, why do I love Texas so much.

 

[deleted1149159]

I heard that only steers and cheers come from Texas

Man, that was a great movie. Ain't it sad we can't put the real quote on there?

 

[deleted1149159]

I grew up loving San Marcos, New Braunfels, Devil's Backbone, etc. Never really got Austin though I did spend some time on lakes around it. Am looking for a spot on the calendar for Big Bend next year. That said, whenever I visit places like Colorado or Oregon I'm like... wait, why do I love Texas so much.

I did my surgical residency in Houston. Loved the town, but the weather was a misery. Couldn't stay. I need four seasons.

 

[NatCh]

Ain't it sad we can't put the real quote on there?

Nope

 

[deleted1149159]

Nope

Oh, come on! Presentism shouldn't be a thing. And it's a quote from a great movie. Next thing you're going to tell me is that "Blazing Saddles" was more offensive than hilarious.

 

[dtrack22]

 

[air bud]

The future is not in PCR that is for sure. A friend of mine was talking to a guy in Georgia who had to shut down his PCR because Medicare stopped reimbursement....

 

[ExperiencedDPM]

Are you an American or an American’t?

Come on, you’re better than cliches.

Are you a Texan or a Texan't?

Dr. Rogers is a democrat otherwise it would have been too easy to ask if he was a Republican or a Republican’t.

 

[ExperiencedDPM]

In case you didn't know wild speculation always has a happy ending.

So does the massage parlor NatCh goes to……

 

[deleted1149159]

Come on, you’re better than cliches.

Dr. Rogers is a democrat otherwise it would have been too easy to ask if he was a Republican or a Republican’t.

I just spewed soda all over my computer monitor!!

 

[thefootfixer]

Not to be a jerk, but most threads tell one how to make the most of an honestly bad job market.

People considering podiatry should think long and hard, but those beyond their first year in school it is best to stay and be proactive.

1. Be geographically open for the best residency

2. Be geographically open for the best job Midwest is often your best chance for living in a city larger than 60,000. Use any hometown connection you have for hospital, Ortho, MSG jobs and stay in touch with hometown podiatrists during school and residency.

3. Have the mindset before residency you might need to open up your own office eventually. Try to learn what you can about private practice in residency and have mentors. A couple years of private practice experience before opening an office really helps.....unless you are just doing nursing homes and working Medi/Medi clinics.

4. If you are in a saturated area and can not move for family reasons you might have to leave one bad job for another slightly better bad job just beyond the no compete radius. At some point you will have to take the gamble to open up an office and probably do things a bit more scammy than you thought to pay the bills.

5. If there is an undeserved area not too far away from where you must live (there often are), could you move at least an hour or two away from family? If no podiatrists are employed by hospitals in the underserved area try to create your own hospital job. If they will not hire you, see if they can at least assist you....maybe waive you your lease for a year in their office space and market for you if you move there. Any help will still be taxed as income if not employed other than maybe marketing.

You can keep working the associate job and pray a hospital or VA job opens up close to where you live.....but you need to stand out or have connections to have a good chance. Make sure your CV looks good. Take leadership positions (one reason to join APMA, but you can also be active with hospital, medical societies, charities etc)!and make sure you get board certified by ABFAS, preferably RRA. You will also be a better applicant for jobs further away if you decide you can move away from family later. Delay buying a house and a new car.....easier to move for a better job and save money to open your own practice

There are not enough good jobs in this profession. The only way to fix this is cut supply.

There are probably enough opportunities to open offices outside of the most saturated areas and do very scammy things to do better than being an associate.

6. You could can go in a time machine and go back in time. Choose a different profession where there are jobs everywhere with signing bonuses, relocation assistance and student loan assistance/forgiveness.

What kinds of “scammy” things?

Even so I’m sure it’s still better that ****ty associate job. Associates just have the stability of a “small but steady salary” but that’s really it

 

[ExperiencedDPM]

What kinds of “scammy” things?

Even so I’m sure it’s still better that ****ty associate job. Associates just have the stability of a “small but steady salary” but that’s really it

Scammy things…..PCR testing on everything, nerve biopsies, laser for fungal nails, “balance” braces, amniotic grafts weekly for pinpoint wounds, billing ORIF of a talo tarsal dislocation when actually performing an arthroereisis, billing for an inter-cuneiform arthrodesis when only placing a screw across the joint. Billing for a 14040/skin or soft tissue rearrangement/transfer when excising a skin ellipse during a hammertoe repair, unbundling a hammertoe or bunion into multiple codes, selling all kinds of useless crap to patients, charging for post op visits for some contrived “complication”. If I wasn’t headed to the gym I would be able to go on for hours.

 

[air bud]

Scammy things…..PCR testing on everything, nerve biopsies, laser for fungal nails, “balance” braces, amniotic grafts weekly for pinpoint wounds, billing ORIF of a talo tarsal dislocation when actually performing an arthroereisis, billing for an inter-cuneiform arthrodesis when only placing a screw across the joint. Billing for a 14040/skin or soft tissue rearrangement/transfer when excising a skin ellipse during a hammertoe repair, unbundling a hammertoe or bunion into multiple codes, selling all kinds of useless crap to patients, charging for post op visits for some contrived “complication”. If I wasn’t headed to the gym I would be able to go on for hours.

Nah bro. Only PCR wounds after mechanically removing bioburden. Science!

And that soft tissue rearrangement is nice might have to work that one into the rotation. I appreciate the billing tips

 

[icebreaker32]

What kinds of “scammy” things?

Even so I’m sure it’s still better that ****ty associate job. Associates just have the stability of a “small but steady salary” but that’s really it

ExperiencedDPM nailed it......yes choosing what scammy things to do and how often you do them for yourself rather than doing them as an associate is better IMO. It is better, maybe, but still bad and you will be at risk for paybacks and potentially state board action if you bill too many services for what is reasonable to treat a given pathology. It is harder to prove, but not impossible when you get greedy and patients start complaining to boards.

Even better yet would be for there to be a reasonable supply and demand for podiatry, so the scammy factor would be much lower in PP.

 

[air bud]

ExperiencedDPM nailed it......yes choosing what scammy things to do and how often you do them for yourself rather than doing them as an associate is better IMO.. it is better maybe, but still bad and you will be at risk for paybacks and potentially state board action if you bill too many services for what is reasonable to treat a given pathology. It is harder to prove, but not impossible when you get greedy and patients start complaining to boards.

Even better yet would be for there to be a reasonable supply and demand for podiatry, so the scammy factor would be much lower in PP.

There is a demand for Podiatry..... In the midwest. I hear it's lovely this time of year.

 

[ExperiencedDPM]

Nah bro. Only PCR wounds after mechanically removing bioburden. Science!

And that soft tissue rearrangement is nice might have to work that one into the rotation. I appreciate the billing tips

I will make sure you’re caught as soon as you try it. The big insurers are scrutinizing this cpt code and it’s going to start triggering automatic reviews. I know……they consulted with me and a plastic surgeon.

 

[Pronation]

I will make sure you’re caught as soon as you try it. The big insurers are scrutinizing this cpt code and it’s going to start triggering automatic reviews. I know……they consulted with me and a plastic surgeon.

There are so many CPT codes out there. Could you tell me which one specifically so I know which one to avoid?

 

[ExperiencedDPM]

There are so many CPT codes out there. Could you tell me which one specifically so I know which one to avoid?

Bill honestly and only bill for the procedure(s) you actually performed. Don’t embellish and don’t unbundle and you won’t have to know which to avoid.

 

[air bud]

You guys are talking about fancy cars when we are supposed to be talking about all the doom and gloom associated with podiatry. Stick to the script.

 

[Redsting]

ExperiencedDPM nailed it......yes choosing what scammy things to do and how often you do them for yourself rather than doing them as an associate is better IMO. It is better, maybe, but still bad and you will be at risk for paybacks and potentially state board action if you bill too many services for what is reasonable to treat a given pathology. It is harder to prove, but not impossible when you get greedy and patients start complaining to boards.

Even better yet would be for there to be a reasonable supply and demand for podiatry, so the scammy factor would be much lower in PP.

I was just talking to someone the other day about this. Billing a wound debrided on follow up for an ingrown nail. Laceration management post op. Bone biopsy, a flap, and amputation when amputation a toe. I know someone who got kicked of BC BS for one of those. I know another who hasn't been audited, is an associate mill, and makes more money than anyone I know. You have to be shady and shameless to pull some of those.

 

[dtrack22]

Laceration management post op. Bone biopsy, a flap, and amputation when amputation a toe.

That’s some Boffeli type coding right there…

 

[heybrother]

Medial and Lateral Plantar Artery Angiosome Rotational Flaps for Transmetatarsal and Lisfranc Amputation in Patients With Compromised Plantar Tissue

Traditional incision techniques for midfoot amputation might not provide immediate soft tissue coverage of the underlying metatarsal and tarsal bones in the presence of a large plantar soft tissue defect. Patients undergoing transmetatarsal and Lisfranc amputation frequently have compromised...

www.jfas.org

When does a TMA become a rotational flap.

 

[ExperiencedDPM]

Medial and Lateral Plantar Artery Angiosome Rotational Flaps for Transmetatarsal and Lisfranc Amputation in Patients With Compromised Plantar Tissue

Traditional incision techniques for midfoot amputation might not provide immediate soft tissue coverage of the underlying metatarsal and tarsal bones in the presence of a large plantar soft tissue defect. Patients undergoing transmetatarsal and Lisfranc amputation frequently have compromised...

www.jfas.org

When does a TMA become a rotational flap.

This is a tricky issue. There is a difference between a complicated closure and a true soft tissue transfer or rearrangement.

Rotating tissue from point A to point B is usually NOT considered a soft tissue rearrangement or transfer. Protecting and “rotating” the corresponding blood supply is part of the procedure and not an island flap, etc. Moving lateral tissue medial or vice versa or moving plantar skin dorsal or vice versa, etc., is not a soft tissue transfer or rearrangement.

There is a “general” rule to determine if a procedure is truly a soft tissue transfer or rearrangement. Of course there are always exceptions but the general rule is that there must be a DONOR site and there must be a RECIPIENT site. And each site should require separate closure.

If it doesn’t meet that general rule, the chances are it’s not being appropriately billed or coded.

Again, there is a difference between a soft tissue transfer/rearrangement and a complicated closure.

I have a call into my colleague who is a plastic surgeon and a frequent consultant regarding correct coding. I will report back when I hear from him.

 

[Jummy Biffett]

I will make sure you’re caught as soon as you try it. The big insurers are scrutinizing this cpt code and it’s going to start triggering automatic reviews. I know……they consulted with me and a plastic surgeon.

Nothing like podiatrists holding down other podiatrists, especially when one has a Lamborghini in his profile picture. I agree with you on the misuse of the code but do we really need to be aggressively policing each other's billing practices? In this economy!

 

[ExperiencedDPM]

This is a tricky issue. There is a difference between a complicated closure and a true soft tissue transfer or rearrangement.

Rotating tissue from point A to point B is usually NOT considered a soft tissue rearrangement or transfer. Protecting and “rotating” the corresponding blood supply is part of the procedure and not an island flap, etc. Moving lateral tissue medial or vice versa or moving plantar skin dorsal or vice versa, etc., is not a soft tissue transfer or rearrangement.

There is a “general” rule to determine if a procedure is truly a soft tissue transfer or rearrangement. Of course there are always exceptions but the general rule is that there must be a DONOR site and there must be a RECIPIENT site. And each site should require separate closure.

If it doesn’t meet that general rule, the chances are it’s not being appropriately billed or coded.

Again, there is a difference between a soft tissue transfer/rearrangement and a complicated closure.

I have a call into my colleague who is a plastic surgeon and a frequent consultant regarding correct coding. I will report back when I hear from him.

Okay, I just heard back from my friend. A well known and respected plastic surgeon who is an expert in these procedures and coding. He was a little sarcastic.

He said it was a good article to determine the best approach to incision planning and wound healing. But he’s not sure that you get paid to make common sense decisions. He said “aren’t all incisions based on best practices to achieve best outcomes.”

He also said “I am not sure what new point the authors are trying to make”. His feeling is that it is simply a different incision and approach to close the wound, but it’s not a procedure that warrants an additional CPT code.

So he agrees that this does not qualify for additional payment or flaps, transfers, etc.

 

[ExperiencedDPM]

Nothing like podiatrists holding down other podiatrists, especially when one has a Lamborghini in his profile picture. I agree with you on the misuse of the code but do we really need to be aggressively policing each other's billing practices? In this economy!

Amateur….that’s not a Lambo. And you’re right, we should close our eyes to fraud since the economy sucks. I stand corrected.

 

[Feli]

You can expect to make $85k working in some crappy private practice office as the supply grossly exceeds demand from these new pod schools unnecessarily flooding the market with more pods. You might get lucky and get hospital based employment for 300k though (shudder), if they choose you out of 100+ other applicants.

This is isn't too far off...
I think the hospital jobs aren't as hard to get as we think (with good training and/or VERY flexible on location).
Also, the PP jobs usually pay quite a bit better than that... for now, until the new schools flood more areas/associates. It's very plausible that almost any metro city becomes as bad as NYC, Phila, Det etc for associate offers.

Basically, 3 choices just as we've had for awhile:
1) PP associate (try for partner)... ok income, good hours typically... can try to get good/great income with partner if it's and ethical group and/or "creative" billing.
2) Hospital job... good income, usually better benefits, hours typically rough, call and weekends can be taxing... sizable risk of burnout / divorce / frustration / etc.
3) Entrepreneur... bad/ok hours and low income at first with notes and staffing/system/marketing development, potential to improve both hours and income significantly... might be tough to get financing or have to do NHs to get going.
4) NHs... I don't really consider this a viable 2020s choice to use 5-10% of our skill set and do a chip and clip job that a MA or LPN can do when we do a hospital surgical residency, but some ppl seem to like it. There is obviously a ton of fraud when most pts are dementia or non-verbal also.

The vast majority of DPMs out of training will obviously do PP of some form (pod >> MSG >>>>> ortho) with hospital jobs in 2nd place - and climbing. It comes down to training and connections; it always has. There are more and more hospital jobs, but they can be open for a reason. Someone with top flight training and ABFAS and decent networking can probably find a few good private hospital job offers, but someone with low level training is stuck cold calling and hoping for a miracle hospital job in VA or highly rural area.

Personally, I like the PP thing. Plenty of large groups - and even some small with partner - pay well... probably more per hour than some hospital jobs due to no weekends/eve call. That said, it sure helps to have a financially competent partner (for any job, podiatry or other). Mainly, I like the reasonable PP hours and no required call (just follow my own pts or occasional new ER/inpt surgical ones if I want to). I don't leave a ton of money on the table (esp surgical CPTs, since the pts are so much time and work), but I sure don't send every toenail clip for PCR or make orthotics for every new pt either. I did the hospital FTE thing, and it sure gets old doing 10pm gas gangrene or 8am Sunday osteomyelitis HWRs. Not for me. Some ppl might have it figured out better or not mind it if they can pulverize student loans fast.

 

[DexterMorganSK]

Stick to the OP, please.

 

[619]

I will make sure you’re caught as soon as you try it. The big insurers are scrutinizing this cpt code and it’s going to start triggering automatic reviews. I know……they consulted with me and a plastic surgeon.

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.

 

[619]

Stick to the OP, please.

The future of podiatry or medicine in general is based on CPT codes and reimbursement.

 

[DexterMorganSK]

The future of podiatry or medicine in general is based on CPT codes and reimbursement.

I was referring more to the interest in "automobiles" in this thread; I deleted a few of those posts
if you guys want to talk about cars..and there seems to be an interest in the topic..please create another thread; no need to derail this thread

 

[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 am consulted to review the good, the bad and the ugly. I go to bat for colleagues whenever possible. But the fraud is rampant and there are things I can not and will not defend. My job is to explain proper coding, etc. I don’t get involved with office visit coding, etc. I am consulted on surgical cases.

And yes, I have solicited and have been solicited by national insurance companies and have personally been responsible for several policies you’ve likely used on a regular basis. And my suggestions have decreased the friction and requirements for approval for several common surgical procedures.

Other than blatant fraud, the majority of denials are for simple lack of documentation.

I have reviewed for over 45 companies and not one has any “conspiracy” to deny claims.

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.

 

[ExperiencedDPM]

The future of podiatry or medicine in general is based on CPT codes and reimbursement.

It’s based on honesty, integrity and appropriate billing. The outliers and those who practice fraud on a regular basis put us all in this mess.