Key Insights On Conservative Care For Adult Flatfoot

Although a variety of surgical treatments are available for adult flatfoot, conservative treatments such as night splints and orthoses can be effective in managing the deformity. These authors provide keys to a thorough clinical exam of these patients, insights on accessing the severity of the flatfoot deformity and a review of conservative treatment options.

The adult flatfoot deformity is a condition that lends itself to many treatment options whether they are conservative or surgical. Formulating a proper treatment must begin with evaluating and categorizing the deformity.

   The evaluation of an adult flatfoot requires ascertaining a pertinent patient history that includes the onset of the deformity, the timing of symptoms and the severity of past and current symptoms. One may elicit a family history of flatfoot deformity. Van Boerum and colleagues showed that associated conditions including rheumatoid arthritis, seronegative arthropathies, hypertension or diabetes may be significant in the adult patient with flatfoot.¹ Occupation, activity level and obesity are other possible contributory factors. Footwear, the history of trauma and previous treatment are other significant factors. The authors also emphasize a pertinent review of systems.

   We can categorize the flatfoot deformity as either a residual flatfoot deformity from a developmental etiology or an acquired deformity. Myerson showed that developmental causes include abnormal joint development, tarsal coalition, a congenital vertical talus, accessory navicular and generalized ligamentous laxity from Marfan’s syndrome or Ehlers-Danlos syndrome.² As Myerson notes, the acquired flatfoot condition is associated with posterior tibial tendon dysfunction (PTTD), midfoot laxity, subluxation of the talus, traumatic deformities, a ruptured plantar fascia or Charcot foot as well as neuromuscular imbalances from polio, cerebral palsy, closed head injuries or following a cerebrovascular accident.

   Importantly, tightness of the triceps surae complex and isolated gastrocnemius tightness have a profound effect on the longitudinal medial arch. Johnson and Christensen performed a three dimensional evaluation of the first ray in cadaver models with variable Achilles tendon tension.³ They found the influence of the peroneus longus on the medial column diminishes with increasing Achilles load. Equinus on an intact longitudinal arch seems to affect the distal components of the medial column, primarily in the frontal plane. Furthermore, the authors say with increased pull on the Achilles, a measurable arch flattening effect occurs with plantarflexion of the talus and navicular, and dorsiflexion of the first metatarsal and cuneiform.

Assessing The Extent Of The Deformity

When assessing the extent of flatfoot, clinicians should perform a thorough clinical examination in conjunction with plain film X-rays. With the patient seated in the exam chair, one can focus on the neurological and musculoskeletal portions of the clinical exam. The musculoskeletal examination should account for any gross deformities, symptomatic sites or malalignments. Perform a comprehensive non-weightbearing biomechanical exam including the Silfverskiöld test for equinus, subtalar range of motion and neutral position, forefoot to rearfoot alignment, forefoot hypermobility and first metatarsophalangeal joint range of motion. When it comes to these biomechanical exams, perform these exams with the forefoot both loaded and unloaded.

Source : http://goo.gl/ppltsN

Bill CPT Code 99214 (or 99204) for podiatry

E/M codes are not specific to certain types of providers. A podiatrist can bill any level of office visit code, provided his documentation supports that level and that the documented history and exam are medically necessary to the patient's problem.
*
If you are going to code based on the key elements of history, exam, and medical decision making, you need to achieve the levels in the code descriptors. For example, for a 99204 you need comprehensive history, comprehensive exam, and moderate complexity medical decision making. It sounds like your concern is the exam portion. While it may be true that a podiatrist isn't going to do a head to toe comprehensive exam, he may do a comprehensive exam per the 1997 musculoskeletal or neuro specialty specific exams. You can find these listed in the 1997 E/M Guidelines here on check out the handy sheets at https://www.novitas-solutions.com/em/scoresheets.html.
*
The other thing to think about is whether counseling and/or coordination of care dominate the visit. If your podiatrist is spending large amounts of time with the patient and more than 50% of that time is spent on counseling or coordination of care, you might be able to bill based on time. You should only code an E/M service based on time alone if at least 50 percent of the visit was spent on counseling or coordination of care, and this fact must be noted in the documentation. The documentation must contain the following three elements:
• Notation of the total time spent on the encounter
• Notation of the total time spent on counseling and/or coordination of care or the percentage of the visit spent on counseling/CoC
• The reason for/topic of the counseling/CoC

A Guide To Dry Skin Disorders In The Lower Extremity

Author(s): M. Joel Morse, DPM
At this wintry time of year, more patients may be presenting with cracked heels and itchy feet due to dry skin. Accordingly, this author discusses the diagnosis and treatment of different forms of dry skin, including dry skin concomitant with common diseases.

How many times a day to you see any of these conditions: stasis eczema, eczema, atopic dermatitis, contact dermatitis, xerosis, psoriasis or stucco keratosis? To some podiatrists, the skin is just a structure you have to get past in order to get to the bones. However, the skin problems are what bring patients into your office with symptoms like tightness, tingling, itchiness, burning, scaling, flaking and lichenification. When you cannot concentrate on your work because you are scratching, when your sleep is interrupted because of burning, when you have noticeable dry skin patches on your legs, then dry skin is in the fast lane.

   Don’t look past the skin for other podiatric concerns. The skin can be a “mirror” of what is going on in the body. The lower legs and heel are notoriously problematic with dry skin symptoms. However, just because we do not treat the hands and forearms, we still need to evaluate those areas so we get the big picture. The feet do not exist in a vacuum.

   The skin acts as a barrier and protects underlying tissues from infection, desiccation, chemicals and mechanical stress. Disruption of these functions results in increased transepidermal water loss and deceases in the stratum corneum’s water content, and is associated with conditions like atopic dermatitis, eczema, xerosis, contact dermatitis and other chronic skin diseases. Moisturizers can improve these conditions through restoration of the integrity of the stratum corneum, acting as a barrier to water loss and replacement of skin lipids and other compounds.¹ Despite the knowledge of well recognized aggravating factors, the etiology of dry skin conditions is an enigma and the management of the condition is often suboptimal.²

   In the foot and ankle region, we have three types of skin: plantar skin, which has no oil glands and the largest number of sweat glands anywhere; dorsal skin, which is normal skin; and the skin overlying the shin, which is the thinnest and more prone to injury.

   Dry skin occurs when the stratum corneum is depleted of water. The skin’s outer layer consists of dead, flattened cells that gradually move toward the skin’s surface and slough off. The cells of the stratum corneum have lost their nucleus, are rich in keratin and are known as “corneocytes.”³Intercellular lipids bind the corneocytes together. When this layer is well moistened, it minimizes water loss through the skin and helps keep out irritants, allergens and germs. However, when the stratum corneum dries out, it loses its protective function. This allows greater water loss, leaving your skin vulnerable to environmental factors.

   Under normal conditions, skin requires a water content of 10 to 15 percent to remain supple and intact.⁴ This water gives the skin its soft, smooth and flexible texture. The water comes from the atmosphere, the underlying layers of skin and sweat. Oil produced by skin glands and fatty substances produced by skin cells act as natural moisturizers, allowing the stratum corneum to seal in water. The skin contains natural moisturizers: ceramides, glycerol, urea and lactic acid. These help rehydrate skin to prevent water loss, which is the reason that many of the products out on the market contain urea, lactic acid, salicylic acid and glycol. They are trying to “mirror” the skin. The essential ingredient of an emollient is lipid (fats, waxes and oils).⁵

^{Original Source:} http://www.podiatrytoday.com/guide-dry-skin-disorders-lower-extremity

64704 Denials? 5 ways to Fix Your Neuroplasty Claims

If you’re just plodding though nerve surgery claims, you could be stepping over a great deal of well-earned reimbursement.  Coding and billing peripheral nerve surgeries for conditions such as tarsal tunnel and diabetic neuropathy can involve a frazzling number of codes.   Podiatry coders often struggle to navigate the various coding guidelines that payers use for these procedures.  Use these five tips to maximize payment for your podiatrist’s hard work on nerve surgeries:

Tip 1: Check CCI edits and your local Medicare guidelines

If you’re billing codes that the Correct Coding Initiative bundles together — and your documentation and diagnosis codes can’t justify breaking the bundle — you’re not going to see one extra cent for that bundled procedure code.

Example: A California Medicare patient injures his foot when he falls off a ladder and requires peripheral nerve surgery to correct the damage the injury caused.  The podiatrist performs the following:

28035 — Release, tarsal tunnel (posterior tibial nerve decompression)

64712 — Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve

64704 — Neuroplasty; nerve of hand or foot

+64727 — Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis)

64708 — Neuroplasty, major peripheral nerve, arm or leg, open; other than specified.

If you report all these codes, you’re bound to get a denial on 64704 — this is one of the codes the Correct Coding Initiative (CCI) bundles into 28035.  Unless you can justify billing 64704 separately (and if that’s the case, append modifier 59, Distinct procedural service, to the code), you shouldn’t list it all.

Unbundling is not automatic: Be aware that you can’t automatically override a CCI edit with modifier 59 just because documentation supports a separate site, incision, or patient encounter, says Claudia Kernaghan, CPC, coder for Nevada Imaging Centers in Las Vegas.  Before appending modifier 59, check the modifier indicator for the bundled code pair.  You’ll find the modifier indicator in Column F of the CCI Excel spreadsheet, which you can download from the NCCI Edit Page of the CMS website.  A modifier indicator of “0” means that you may not unbundle the edit combination under any circumstances.  Alternately, a “1” indicator opens the possibility for you to override an edit using a modifier if your documentation supports that the procedures are distinct from one another and meets the criteria described in the definition of modifier 59. 

Reporting 64712 could also raise some eyebrows with the insurance carrier.  Podiatrists don’t normally report this code because the sciatic nerve is not something a podiatrist normally works on.  Use caution when reporting this code because of the anatomic location of the nerve it refers to, and check first whether the carrier will pay the podiatrist for this procedure.

Tip 2: Make sure diagnosis codes match procedure codes

You might be tempted to report 355.71 on a workers’ compensation claim to show that the patient’s problem is the result of a traumatic injury, and therefore justifies reporting 28035.  But if the only accepted primary diagnosis for the surgery is 355.5, carriers will reject your claim.

Tip 3: Code the highest RVU procedure first

Order does make a difference. You should always code first the procedure with the highest value because under multiple surgery rules, the subsequent procedure codes will only merit half of the normal reimbursement.  In the example above, you should not list 64708 first because it only has 14.12 non-facility RVUs. Code 28035 has 14.84 non-facility RVUs, and therefore should be the first code you report.

Tip 4: Work out jurisdiction and fee schedule for workers’ comp claims

If you’re not paying attention, you could lose out big with your workers’ comp patients. Workers’ comp has its own set of rules, and deviating from them can lead to numerous denials. When billing workers’ comp claims, you need to look out for a number of things: Does the documentation support the billing? If the podiatrist bills for working on the sciatic nerve, does the documentation state how and why he worked on this nerve?  Are you billing the correct jurisdiction for the payment? If the patient is a Colorado resident but sustained the injury working in California, you need to follow the fee schedule of the state in which the patient’s first WC claim was filed.  Are you billing with the correct year CPT® manual? Not all WC carriers use the current fee schedule, so if you’re using new codes that aren’t in the WC fee schedule, you won’t get paid.  Are all of the procedures WC-related and authorized? If a patient decided to have a bunionectomy performed at the same time as the peripheral nerve surgery, WC won’t pay for it if the bunionectomy is not related to the work injury.

Tip 5: Append modifiers if multiple surgery rules apply

This can be especially important if you are performing the same procedure multiple times on the same foot.

Example: A typical tarsal tunnel case on the right foot would be 28035-RT linked to diagnosis code 355.5, along with 64704-RT, 64704-RT-59, and 64704-RT-59.  One of the difficulties in coding peripheral nerve surgery is that CPT® lacks a code to describe a three- or four-nerve release.  Code 64704 is a possible fit when the podiatrist performs a release of the nerve that is past the tarsal tunnel. So before coding in this manner, ask the carrier for its guidelines in this situation.

If the carrier will allow 64704 for a release of the nerve past the tarsal tunnel, you should report 64704 three times — once for the medial nerve, once for the lateral plantar nerve, and once for the calcaneal nerve that are all on the same foot, Larson says. Modifiers RT and 59 help indicate the podiatrist is performing the procedure on distinct parts of the same foot.

99212 or 99213 For Podiatry E/M Claims? MDM Level Is Your Key To Success

Diabetes patients can present podiatrists with some of their most complex cases and if you don’t evaluate the level of medical decision-making your podiatrist performs for such patients, you can be at risk of undercoding the services—and losing out on money.

Although diabetes patients are regular fixtures in podiatry practices, many podiatry coders inappropriately code the correct E/M level for these visits because they don’t properly evaluate the level of medical decision-making these more medically complex patients require.

The problem: Assessing the history and exam components of an E/M is fairly straightforward, but medical decision-making (MDM) is complex—requiring you to asses three separate categories:

• number of diagnoses/management options (minimal, limited, multiple, extensive)
• amount and complexity of data (minimal, limited, moderate, extensive)
• level of risk (minimal, low, moderate, high).

To determine the level of risk, you must also assess three subcategories:

• presenting problem
• diagnostic procedures ordered
• management options.

Many podiatry coders slip up on MDM and downcode their claims resultantly.

The solution: Follow these steps to properly assess a visit’s level of MDM and ensure your DPM’s E/M code levels are appropriate.

To determine the level of MDM, you should assign points to each of the three MDM components that your podiatrist performs. The number of points in each category determines the final MDM level. You must have two out of the three MDM components score at a particular level in order to assign that level of MDM. For example, if the number of diagnoses is low, but the amount and complexity of data and level of risk are both moderate, your MDM score is moderate.

Use this overall MDM scoring scale to determine MDM level:

• 2-3 “minimal” components: straightforward decision-making
• 2-3 “limited” components: low decision-making
• 2-3 “moderate” components: moderate decision-making
• 2-3 “extensive” components: complex decision-making.

1. Learn Each Level of Diagnosis

Start your MDM level assessment by tackling the first category: number of diagnoses. For this category, ask, “What is wrong with the patient?” and “What is the total number of medical diagnoses that he has?”

Example: A diabetic patient with hypertension comes in complaining of toe pain. She has three diagnoses: the chief complaint of toe pain (729.5, Pain in limb), diabetes (250.xx) and hypertension (405.99).

Score: For each diagnosis, assign a point and score the diagnosis level as follows: minimal (0-1), low (2), moderate (3), high (4+). So in this case, with three diagnoses, you assign “moderate” as the diagnosis level.

2. Classify Your Data Complexity

Score the complexity of data in the same manner: minimal (0-1), low (2), moderate (3), and high (4+). Assign one point per class of data.

This means no matter how many X-rays or labs the podiatrist orders, you can only assign one point for ordering and reviewing all of the data in each of those two classes.

The classes of data you should consider are:

• Review/order of clinical labs
• Review/order of radiology
• Discuss results with test-performing physician
• Independent review of image, tracing or specimen
• Decision to obtain old records/ obtain history from someone other than patient
• Review and summarize old patient records

The podiatrist reviewing X-rays and MRIs, and calling the patient’s vascular doctor or the radiologist who reviewed the MRI – all of those bump up the level and the complexity of the data.

Example: A 14-year-old patient on vacation presents with an infected cut on the plantar surface of his foot that he sustained when he slipped and landed on jagged shore rocks at the beach. He also complains of severe pain in a different region from the laceration. The podiatrist orders blood work and X-rays and calls the patient’s primary physician for a complete medical history.

Score: Three points. You should assign one point for ordering and reviewing the lab work, one point for ordering and reviewing X-rays, and one point for obtaining the patient’s medical history from his primary physician. The level of amount and complexity of data is therefore “moderate.”

3. Examine the Risk

The final of the three MDM categories, level of risk, can be the most difficult part to determine.

Level of risk involves three subcategories: presenting problem, diagnostic procedures ordered, and management options. The highest scoring of the three categories determines if the patient’s risk level is minimal, low, moderate, or high. The Centers for Medicare and Medicaid Services’ 1995 guidelines for MDM contain a “Table of Risk” with examples of what constitutes each level of the three subcategories.

4. Change the Charge With MDM

To see how MDM level can affect E/M level, study these two examples of podiatry’s most frequently billed office visits – 99212 and 99213 (Office or other outpatient visit for the evaluation and management of an established patient …).

Example: A 16-year-old established patient complains of pain in her right hallux valgus. The pain is constant and throbbing, and has been for three days. The podiatrist reviews her skin and musculoskeletal systems, and performs a dermatological exam of the toe, diagnosing the patient with an ingrown toenail that will require surgery.

Breakdown: The medical decision-making here is straightforward. You have one diagnosis: an ingrown toenail. This means the level for number of diagnoses is “minimal.” The podiatrist wouldn’t order any labs in this case unless the toe is infected, in which case he would order blood work to check the patient’s white blood cell count. You should therefore assign either “0″ or “1″ for the amount and complexity of the data, which gives you a data level of “minimal.”

For level of risk is one self-limited problem, which qualifies as “minimal.” If the podiatrist ordered blood work, the ordered diagnostic procedure (venipuncture) also scores as “minimal.” And the management options are “low” because the patient requires minor surgery with no risk. The highest scoring component within this level of risk assessment is “low,” therefore the overall level or risk is “low.”

Final MDM: With two of the three MDM components scoring “minimal,” you have straightforward MDM. If we assume that the history and exam are problem-focused, and therefore also “minimal,” you should assign an E/M level of 99212.

Example #2: Consider the same scenario as above, but the patient is a diabetic on Coumadin, and the ingrown toenail is infected and draining a clear fluid. The podiatrist performs both dermatological and musculoskeletal exams, prescribes antibiotics for the infection, and arranges to see the patient again in five days to evaluate her for surgery.

Here, the patient has a low number of diagnosis and management options (diabetes and ingrown toenail), minimal data (clinical labs on diabetes and white count), but a low level of risk. In terms of management options, the surgery is minor, with added risk factors because of the diabetes and Coumadin, and the prescription drug management. These factors raise the level of risk to “moderate.”

Final MDM: You would assign this visit with low MDM level, along with an extended problem- focused exam (2-7 systems examined). Because established patients only require two of the three components, the MDM helps raise the E/M to a 99213.

Cut Medical Bill with these Top 10 Secrets

With health-care costs on the rise, you may be looking for ways to lower your medical expenses. Here are 10 ideas:
1. Practice prevention
2. Shop around for health insurance
3. Cut the cost of prescription drugs
4. Check your medical bills.
5. Join your spouse's health plan
6. Keep track of your medical expenses
7. Negotiate a discount with your health-care provider
8. Contribute to a flexible spending account
9. Take advantage of free health screenings
10. Get to know your health

5. Join your spouse's health plan 6. Keep track of your medical expenses 7. Negotiate a discount with your health-care provider 8. Contribute to a flexible spending account 9. Take advantage of free health screenings 10. Get to know your health
Read more at: http://www.edoctoronline.com/medical-health-insurance.asp?Top-10-Ways-to-Cut-Your-Medical-Bills=0&c=2&articleid=8915. Join your spouse's health plan 6. Keep track of your medical expenses 7. Negotiate a discount with your health-care provider 8. Contribute to a flexible spending account 9. Take advantage of free health screenings 10. Get to know your health 

Read more at: http://www.edoctoronline.com/medical-health-insurance.asp?Top-10-Ways-to-Cut-Your-Medical-Bills=0&c=2&articleid=891

5. Join your spouse's health plan 6. Keep track of your medical expenses 7. Negotiate a discount with your health-care provider 8. Contribute to a flexible spending account 9. Take advantage of free health screenings 10. Get to know your health
Read more at: http://www.edoctoronline.com/medical-health-insurance.asp?Top-10-Ways-to-Cut-Your-Medical-Bills=0&c=2&articleid=891

Practice prevention
As basic as it sounds, one of the most effective ways to lower your medical expenses over time is to maintain a healthy lifestyle. For example, you can:

Take advantage of wellness programs
Maintain a healthy weight
Exercise regularly
Kick unhealthy habits (e.g. smoking)
Have regular checkups

Shop around for health insurance
If you don't have employer-sponsored health insurance, you may be looking to obtain coverage on your own. To get good coverage at an affordable price, shop around. Because premiums vary widely, you'll probably save money if you get quotes from several companies. Evaluate each plan's coverage and features, taking into account exclusions, limitations, and the freedom to choose health-care providers, among other things. Also find out how much you'll end up paying out of pocket in the form of co-payments, coinsurance, and deductibles, because even relatively small amounts of money can really add up if you make frequent visits to your doctor.

Cut the cost of prescription drugs
Prescription costs can eat up a large portion of your budget if you take prescription drugs regularly. Fortunately, it's not hard to find ways to save money. For example, try ordering your prescriptions through the mail, using a traditional or online pharmacy. If you belong to a prescription drug plan (e.g. through your health insurance), you may be able to get a three-month supply of your prescription drug through the mail for the same price you would pay for a one-month supply at your neighborhood pharmacy. You can also ask your pharmacist or doctor to recommend a less-expensive generic drug whenever possible.

Check your medical bills
Medical bills are often confusing to read. However, taking a few minutes to go over the charges may save you money in the long run. Check to make sure that the bill accurately reflects the procedures you have undergone and takes into account any applicable insurance coverage you may have. Some errors, such as wrong computer codes, are common, and you may be billed for health care you never received. Contact the appropriate billing office if you think you've found a mistake. If you've received an explanation of benefits from your insurance company that you believe is wrong, ask the company to review your claim.

Join your spouse's health plan
Many married couples maintain separate health insurance coverage even though it may not be cost effective to do so. Examine both your coverage and your spouse's coverage to see if it makes sense for either of you to join the other's plan. Keep in mind that most plans allow you to add a spouse to your plan within a certain time period after you get married (e.g. 30 days). Otherwise, you may have to wait for the plans' annual open enrollment period.

Keep track of your medical expenses
Come tax time, you may be able to deduct certain medical expenses if you itemize, and your total medical expenses exceed 7.5 percent of your adjusted gross income. Allowable medical expenses include everything from health-care services to medical aids (e.g. eyeglasses, hearing aids). Keep track of these expenses if there's a chance you'll be able to deduct them on your income tax return.

Negotiate a discount with your health-care provider
Many people don't realize that you can sometimes negotiate to lower your medical bills. While it may not always work, it doesn't hurt to ask your doctor, hospital, or pharmacy if they're willing to come down in price. Before you begin to negotiate, do a little research to find out what other health-care providers in your area are charging. You can also ask your health-care provider if they'll lower their price if you pay in cash up front.

Contribute to a flexible spending account
Your employer may offer a flexible spending plan that allows you to put pretax dollars in an account. You are then reimbursed for your out-of-pocket medical expenses, such as prescription drugs, dental care, and co-payments. Because flexible spending contributions are taken out of your pay before federal and state taxes are calculated, you get to use pretax dollars to pay your medical bills.

Take advantage of free health screenings
If your health insurance doesn't provide adequate coverage in some areas, or if you don't have any health insurance coverage at all, you may want to look into free health screenings. Local clinics and hospitals often provide a variety of screenings, such as blood pressure, cholesterol, and mammograms.

Get to know your health insurance
Your health insurance may cover more than you think. Nowadays, insurance companies often provide benefits designed to help you stay safe and healthy. For example, you may receive discounts on vitamins, alternative medicines, health club memberships, or bike helmets. You may also be surprised at the range of coverage your health plan offers. For instance, it may cover dental care for young children, chiropractic care, and acupuncture. Read your plan membership materials to find out what products and services are available through your health plan before you pay for them on your own.

Please note that this description/explanation is intended only as a guideline.

Secrets 

How Will Obamacare Affect Podiatry?

Author(s): 

Neal Frankel, DPM, FASPS, FACFAS        

Podiatrists and patients alike may experience some confusion with the deluge of information regarding the Affordable Care Act (ACA). This author discusses the insurance exchanges and what constitutes a “qualifying health plan” with the ACA, raises questions about potential obstacles with ACA and suggests proactive strategies to help ensure adequate reimbursement in the future.


With all of the news blasting on the television 24/7 about the Affordable Care Act, also known as Obamacare, do you think you have enough information to be ready for the changes in the way your patients receive their insurance coverage and be able to get paid for your services?

   Unfortunately, many of the news stations are very biased in their coverage depending on the station you watch. Fox News blasts the plan at every turn while MSNBC tells its listeners that this law is the next best thing to sliced bread. I hope to give you all of the facts I have been able to compile to date and include my personal opinion as to what you need to do to continue being profitable with all of the changes you will see in regard to patients’ coverage and how you will be reimbursed.

   Many of my sources include high-level healthcare consultants, insurers and government sources. Again, each of them presented the facts as the facts were presented to them but I still detected a definite bias in how they presented these facts. I will first list the definition of the many components of the law and what it means to the patients purchasing these plans. Then I will discuss the reimbursement issues that we will face and how we as podiatrists will be able to treat these patients in the years to come.

   I am sure you have been aware of the government Web site for the federal exchange and its inability to allow access for patients to purchase these plans, but not much is being reported as to what will happen once people are finally able to sign up. To date, it is not clear whether the information the Web site obtains will actually result in patients enrolled in the various plans and whether their personal information collected will have adequate protection. It is also unclear on how the insurers receive subsidies for the money they outlay and how physicians get paid.

A Closer Look At The Insurance Exchanges

There are several types of delivery models that will allow patients to purchase insurance. These include the state health insurance exchange, the federal health insurance exchange and joint-run exchanges. In addition, many insurers have included their plans on their individual Web sites and through insurance agents as they were available before.

   Affordable Care Act state health insurance exchanges can run a number of different ways. States can build a health insurance exchange on their own, partner with one or more other states, run a joint exchange with the federal government or have the federal government build and run the insurance exchange for them. January 1, 2014 was the deadline for all exchanges to be fully operational. Only states that build their own exchange receive full government funding.

States that set up their own exchange get to directly determine which companies can compete in their exchange and negotiate benefits and prices. In a federal exchange, the U.S. Department of Health and Human Services (HHS) does this for them. In a joint-run exchange, any carrier meeting the minimum federal and state requirements can compete in the exchange.

Source: http://www.podiatrytoday.com/how-will-obamacare-affect-podiatry