However, it doesn’t matter if my receptionist explains this on the phone before the first assessment, I still get asked on many occasions to manipulate my billing so that coverage for their custom made foot orthotics are covered when their insurance company requests.
As a certified pedorthist, I strive to be as ethical as possible as I take my job very seriously and I don’t want to lose my certification to practice and provide this service to my clients.
But many fraudulent claims are billed on an ongoing basis that get red flagged by insurance companies that end up calling my association to ask a certified pedorthist to review a claim that they suspect to be fraudulent. The majority of the time these claims are not from certified pedorthist but from other health care professionals adding this extra service onto the service they already provide just to place more money in their pockets.
Here are 5 examples of fraudulent claims that insurance companies deal with on a regular basis include:
- Entire families receiving the same treatment: Similar styles or types of footwear regardless of the individual condition. This is typically done to “max out” the employers insurance coverage for items such as custom made foot orthotics, orthopaedic footwear, shoe modifications or compression stockings
- Patients receiving free shoes with the purchase of orthotics
- Patients billing with inaccurate invoices - billed for orthotics when shoes were only purchased
- Patients billed for some form of orthopaedic treatment when no such treatment was actually provided. In some cases compensation is divided between patient and practitioner
- Patients billed for custom made foot orthotics when they were provided with an item completely unrelated to a Pedorthic treatment
As certified pedorthists, my association has worked extremely hard to implement specific guidelines to be put in place to help identify fraudulent claims. They consist of:
- Having an itemized invoice. All items and modifications must be listed in their own line
- Requiring a biomechanical evaluation
- Requiring a referral from an approved practitioner including a specific diagnosis and request for treatment
- Mandating the service must be provided by an approved foot care professional with proof of professional designation included in submitted paperwork
- Detailed method of orthotic casting and fabrication including the raw materials that were used
Although many insurance companies and third party payers have to push these recommendations into place, all of my billing has each one of the specific guidelines listed above. My association has been working very hard over the past few years to education the insurance companies on these guidelines so that they will not reimburse any claim appears fraudulent. They now have backing if it does look suspicious to them.
I am so thankful for the extra work my association is doing to educate the insurance companies. It allows certified pedorthists to be a recognized health care professional in the foot industry.