F R O M T H E
EXECUTIVE DIRECTOR
Brian Lagana PFA Executive Director brian @ pedorthics . org
Medicare : It ’ s Not the Only Insurance Game in Town
Most pedorthists accept major credit cards and checks , along with cash , as convenient forms of payment from their patients . However , many seem stuck on expanding the base of insurance carriers that they participate with beyond Medicare . In this difficult economy especially , this reluctance is particularly puzzling , as you are constraining your patient base and revenue flow .
When an individual became certified or licensed as a pedorthist , they were essentially indicating that they want to be a service provider in the healthcare world . As a healthcare provider , the first obligation is to your referral source that writes the prescription and sends the patient your way . Secondly , your obligation is to the patient . The only way that you can fully serve your referral sources and their patients is by accepting insurance carriers other than Medicare .
Consider this argument : when you seek a physician for your personal healthcare needs , you try to find one who accepts your insurance plan so you have minimal out-of-pocket expenses , more provider options and convenience . Shouldn ’ t it be expected , then , that you - as the healthcare provider - would extend the same level of insurance options to your patients as part of your business model ?
The only way that pedorthists can truly serve their referral sources and patients is to not only bill Medicare , but also the myriad other third party private payers that your referral sources participate with . By expanding the insurances that you accept , you are allowing your referral sources to send you a larger percentage of their non-Medicare patients for pedorthic services , thereby expanding your business . Consider , too , that expanding your insurance options is insurance for you and your practice – Medicare seems to always be in a state of flux , with new regulations
... when you seek a physician for your personal healthcare needs , you try to find one who accepts your insurance plan so you have minimal out-of-pocket expenses , more provider options and convenience . Shouldn ’ t it be expected , then , that you - as the healthcare provider - would extend the same level of insurance options to your patients as part of your business model ?
and onerous requirements coming out all the time , while reimbursement levels fail to keep pace with the value of your time , the materials that you use , and , as significantly , the administrative time that you use to keep your recordkeeping compliant with Medicare .
Another benefit to accepting other insurance carriers are the doors to opportunity that it can open to not only treating your own patients in your office , but also as a healthcare team member working with other healthcare professionals in hospitals , nursing homes , physical therapy clinics and wound care centers , just to name a few . “ One can pretty much control their patient care services growth by which third party private payers you chose to participate with ,” says Randy Stevens , C . Ped ., COF , BOCP , and Co-Chair of PFA ’ s Government Affairs and Coding Committee . While it is time consuming to initiate a contract with a private insurance company , and the paperwork can be intimidating , Stevens encourages you to consider it with several tips :
1 . When you sign on with a private payer , make sure that you mention you want to provide all of the services within your scope ( s ) of practice so that the contact can be written accordingly .
2 . In some instances , you can negotiate on the fee schedules and services that you will provide to the carrier ’ s beneficiaries (“ Everything is negotiable ,” advises Stevens ).
“ On average , the turnaround time for claims processing is reasonable . However , be aware that , depending on who you select to participate with , reimbursement levels can be as low as 65 % of the Medicare allowables , or 100 % of the Medicare allowables , so do your research due diligence beforehand ,” advises Stevens .
Is it really worth all of the effort ? “ Expanding the insurance options available to your patients , like comfortably utilizing your full scope ( s ) of practice , will endear you to your referral sources as a dependable and competent healthcare provider for their patients , and your patients will love you because they know that you are thinking of them when you accept the insurance card that they are carrying ,” advises Stevens . ■
8 Pedorthic Footcare Association www . pedorthics . org