Podiatry Billing Proposal Worksheet
Send every company the same request. Write their answers here. A blank box means you do not know yet. It never means "included" or "free."
Do not write patient names or claim details on this sheet.
1. Compare the written answers
| What to pin down | Company 1 | Company 2 | Company 3 |
|---|---|---|---|
| Company, contact, date of quote | |||
| Who assigns the codes: them or us? | |||
| Our work covered: foot care, wounds, surgery, DME, orthotics, diabetic shoes | |||
| Eligibility, authorizations, credentialing | |||
| Denials, appeals, patient statements and calls | |||
| Can we keep our EHR and billing system? What changes? | |||
| Percentage or flat fee | |||
| The percentage applies to: everything, insurance only, or another defined base? | |||
| Monthly minimum: amount, start date, floor or extra charge? | |||
| Monthly add-ons: software, clearinghouse, statements | |||
| One-time fees: setup, data move, training | |||
| Old unpaid claims: who works them, for what fee | |||
| Reports, and can we log in to see them? | |||
| Contract length, auto-renewal, notice to cancel | |||
| Cost to leave, data export, signed business associate agreement | |||
| Monthly cost (from the math below) | |||
| First-year cost (from the math below) | |||
| Still unanswered |
2. Do the quote math the same way for each
Fee base = the collections the percentage applies to (everything, or insurance payments only).
Percentage charge = fee base × quoted percentage ÷ 100 (enter 4 for 4%).
Base fee = the larger of the percentage charge and the monthly minimum.
Monthly cost = base fee + required monthly add-ons.
First-year cost = monthly cost × 12 + one-time fees.
Share of all you collect (%) = monthly cost ÷ total monthly collections × 100. Not defined when total collections are $0.
This math assumes the minimum is a floor under the percentage charge, not an extra charge. Round monthly amounts to cents. First-year cost repeats the same month 12 times and adds one-time fees. It excludes any charge not entered, such as separate old-claim recovery or exit fees. For a flat monthly fee, use 0% and put that fee in the monthly minimum. A blank fee leaves the total incomplete; get it in writing before ranking quotes.
Example (made-up numbers). You collect $40,000 a month: $30,000 from insurers, $10,000 from patients. Quote A is 4% of everything, with a $2,000 minimum, $300 a month for software, and a $1,200 setup fee: 4% is $1,600, so the $2,000 minimum applies. Monthly cost is $2,300. First-year cost is $28,800. That is 5.75% of what you collect. Quote B is 5% of everything with no minimum or other fees: $2,000 a month, $24,000 in year one, or 5%. Quote C is 6% on insurance payments only, with no minimum or other fees: $1,800 a month, $21,600 in year one, or 4.5%.
3. Seven questions to ask a podiatry billing service
Ask the proposed account team to explain its process and identify the current policy sources it uses. Mark each answer: confirmed in writing / needs follow-up / outside scope.
- "Do you assign the codes from our notes, or do we send you coded claims?" Good answer: a clear answer about who assigns the codes, plus who asks the provider when a note is missing something.
- "When does Medicare pay for a nail or callus visit, and which modifier goes on it?" Good answer: routine foot care is generally excluded unless an exception applies. Diabetes alone does not establish coverage. Where the applicable policy requires class-finding modifiers, Q7 means one Class A finding; Q8, two Class B; Q9, one Class B and two Class C. The team identifies the coverage pathway and current contractor instructions instead of adding these modifiers automatically. Sources: CMS Benefit Policy Manual, Chapter 15, section 290; Palmetto A56680; CGS A57193.
- "A Medicare patient wants a trim that is not covered. What happens?" Good answer: establish why the service is not covered. GY identifies statutory exclusion or a service outside the Medicare benefit when a claim is submitted; an ABN is voluntary for a statutory exclusion. Expected medical-necessity denials have different notice and liability rules. Do not assume every denied charge becomes the patient's responsibility. Then ask whether the vendor's fee applies to these patient payments. Source: CMS ABN booklet, MLN006266.
- "What are G0245, G0246 and G0247 for?" Good answer: G0245 is the initial LOPS evaluation, G0246 a follow-up, and G0247 the associated routine care. G0247 requires a payable G0245 or G0246 on the same date. This benefit concerns documented diabetic sensory neuropathy with loss of protective sensation; its six-month interval and intervening-specialist restrictions are not a limit on all foot care. Sources: CMS NCD 70.2.1; Claims Processing Manual, Chapter 32, sections 80.2 and 80.8.
- "Do you bill diabetic shoes, and who gets the claim?" Good answer: the DME MAC process and applicable supplier enrollment are addressed. The team checks the order, qualifying records, certification timing, supplier evaluation before selection, and documented fit at delivery. The diabetes-management visit is within six months before delivery; certification is signed on or after that visit and within three months before delivery. A certification signature alone is insufficient. KX requires the policy's coverage criteria; missing KX or an appropriate GA/GY/GZ modifier is a missing-information rejection. Sources: CMS Therapeutic Footwear; Article A52501.
- "A visit and a minor procedure happen on the same day. Who decides if both get billed?" Good answer: a qualified reviewer checks whether the note supports a significant, separately identifiable evaluation and management service beyond the work included in the minor procedure. Modifier 25 is not added automatically. A different diagnosis is not always required. Source: CMS 2026 NCCI Policy Manual, Chapter I.
- "Do we have to move to your software, who owns our data, and who works our old unpaid claims?" Good answer: a direct answer now, and the same answer in the contract.