Podiatry Billing Services
From simple foot care and diabetic nail debridement to bunion surgery, podiatry billing has a unique combination of requirements most general billers miss. DME/orthotics, hammertoe correction, and wound care. Specifically for podiatrists, Sirius Solutions Global creates billing systems—clean claims, fewer denials, and quicker reimbursement—that let doctors focus on patients rather than paperwork.
Our Podiatry Billing Services (end-to-end RCM)
We tailor the revenue cycle to the way podiatrists practice practical, compliant, and built for speed.
1) Eligibility & Benefits Verification
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Sameday checks for copays, deductibles, plan exclusions, and frequency limitations.
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Clear estimates to help staff and patients to prevent surprises.
2) Prior Authorization Management
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We handle pre-auths for surgery (bunionectomy, hammertoe, neuroma), advanced imaging, wound care therapies, and DME.
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Documentation packaging (conservative care, imaging, photos, treatment failure) that payers expect.
3) Specialty Coding & Charge Capture
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Accurate CPT/HCPCS/ICD-10 for:
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Diabetic foot care & nail debridement
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Bunionectomy / osteotomies / hammertoe correction
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Neuroma injections & surgical excision
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Treatments for plantar fasciitis and tendon repairs (Achilles, peroneal)
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Fluoroscopy, if allowed; ultrasound-guided injections.
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Skin substitutes or biologics, wound debridement, and foreign body removal
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Fracture care, strapping, casting
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Custom orthotics and DME include night splints, therapeutic shoes/inserts, and AFOs.
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Correct modifier use (e.g., RT/LT, 50, 59/XS, 26/TC, 25, 51) and units by site/side.
4) Clean Claims & Payer-Specific Edits
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Automated scrubbing applies local/national policies, bundling edits, frequency limits, and coverage rules before submission.
5) Denial Management & Appeals
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Root-cause analysis (medical necessity, bundling, missing proof of delivery, frequency, place of service).
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Fast resubmissions with corrected coding and rock-solid documentation; targeted appeals for high-value cases.
6) Payment Posting & Underpayment Recovery
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ERA/EOB posting, contract checks, and automated underpayment alerts with follow-through.
7) Patient Statements & Support
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Clear, friendly statements and payment options that reduce confusion—and complaints.
8) Reporting & KPIs
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Real-time dashboards for denial rate, AR days, net collections, payer mix, top CPT revenue, and DME performance.
Results you can expect with Compliance & security
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Lower denial rates (especially for “routine care,” bundling, and DME issues)
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Faster cash flow with higher first-pass acceptance
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Recovered revenue from targeted appeals and underpayment reviews
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Happier front desk and clinicians with fewer billing fires to fight
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HIPAA/HITECH-compliant processes and encrypted data exchange
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Role-based access, audit trails, and periodic coding audits
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Payer policy monitoring so your claims reflect the latest rules
Why podiatry billing is uniquely challenging
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Coverage distinctions that trip teams up. “Routine foot care” vs. “at-risk foot care,” nail debridement medical necessity, frequency limits, and Q modifiers for therapeutic shoes all vary by payer.
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Procedure + E/M bundling rules. Knowing when a same-day E/M is separately billable (and how to document a distinct service) matters.
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Laterality and multi-site procedures. Right/left, multiple toes, multiple metatarsals—units and modifiers must line up with documentation.
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Global periods & post-op billing. Minor vs. major procedures change what’s billable during follow-up.
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DME & orthotics are their own world. Correct HCPCS/L-codes, proof of delivery, supplier standards, and medical necessity language can make or break payment.
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Cross-setting complexity. Office, ASC, hospital, SNF, and home health all carry different requirements and edits.
If your team is spending hours fixing denials for “not medically necessary,” “bundled,” or “modifier missing,” you’re leaving money on the table.
What we handle every day
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Routine vs. at-risk foot care documentation and coverage rules
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Nail avulsion & matrixectomy with proper anesthesia and laterality documentation
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Wound care: debridement levels, measurements, photos, biologics, and frequency limits
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Bunion, hammertoe, and forefoot recon (office/ASC/hospital) with global period tracking
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Neuroma care: injections, excisions, and imaging guidance when applicable
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Plantar fasciitis procedures and conservative therapy pathways
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Fracture care & casting/strapping nuances
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DME & orthotics: medical necessity, PDAC when required, proof-of-delivery, refill tracking
Documentation made easy
We provide concise templates and quick checklists so the right details land in the note:
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Medical need connected to pain, functional restriction, risk of infection, or ulceration
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Laterality and exact site include heel, ankle, metatarsal, plantar surface, and toe number.
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Tissue type, length × width × depth, wound details, and method or time of debridement
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Conservative care history for surgical and injection procedures
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DME documentation (fit, function, and physician order) plus proof-of-delivery
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E/M distinctness for same-day procedures (when a separate E/M is appropriate)
Technology & AI that actually helps
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AI-assisted scrubbing catches missing modifiers, frequency conflicts, and mismatched diagnoses before claims go out.
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Denial prediction flags risky claims (routine vs at-risk, frequency issues, DME documentation gaps) so we fix them proactively.
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Payment intelligence audits remittances against contracts to spot underpayments.
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EHR/PM integrations reduce manual entry and missed charges.
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Live dashboards show AR health and payer behavior in real time.
Our promise: technology where it reduces friction; humans where judgment matters.
Quick Helpful Answers
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Let’s protect your revenue step by step
If denials, DME headaches, or bundling surprises are slowing your cash flow, we can help.
Sirius Solutions Global — an extension of your podiatry team, not just another vendor. Request a free baseline audit and we’ll show you exactly where you’re losing revenue and how to fix it.