It’s well known that Medicare doesn’t cover “routine” foot care. This extends to many commonly performed podiatric services such as corn and callus removal and general nail maintenance (cutting, trimming, debridement, etc.). However, there are times when patients have systemic conditions that necessitate what might typically be deemed routine foot care to avoid serious medical complications. Trying to get reimbursed in these scenarios can prove challenging. 

Below are some tips for successfully getting exceptions to the rules:

• Supportive devices and orthopedic shoes are not usually covered, even if a patient has been diagnosed with flat feet. But, if the shoes are an integral part of a covered treatment (i.e., part of a leg brace), they should qualify. 
• Patients with certain systemic vascular, metabolic, or neurological conditions may also be eligible for so-called routine foot care when it can be demonstrated that a professional’s absence of such care could pose a serious medical threat—i.e., poor circulation.
• If you submit a claim for “routine care” for a Medicare patient with complicated conditions, remember to include the name of the M.D. or D.O. who diagnosed the condition and the date the patient last saw that practitioner.
• Don’t just list the complicating condition and expect coverage. Carefully document convincing evidence that having a non-professional perform the routine service you are billing for would be hazardous to the patient. 
• Don’t submit a separate claim for non-covered care required for a covered procedure. If, for example, you need to trim a toenail to get better access for a covered surgical procedure, it should be included in the claim for the covered service.

We can help you avoid billing errors. A Step Above Health Management Systems provides specialized podiatric medical billing services to clients nationwide. Let our firm provide your practice with a plan customized to manage all your billing needs. Please call us at (877) 448-6233 to learn how our solution can save you money and help streamline your billing process.