Podiatry Coding & Billing Alert

This military payer is often the secondary insurance.

No matter how far from a military post you may be, the likelihood is that your podiatry practice will see its share of TRICARE patients. TRICARE can be a slow to adopt trends and policies. For example, the Department of Defense took until October 2013 to propose a rule allowing podiatrists to prescribe DMEs. Some of this government payer’s rules can be confusing initially, but you must follow them to ensure compliance and get your practice paid.

The tips below highlight some aspects of TRICARE billing that can help your practice navigate the payer’s specific guidelines when coding for encounters with military personnel and their dependents.

TRICARE Foot Care Coverage is Similar to Medicare

TRICARE includes coverage for podiatry, including laboratory and radiology services, for the treatment of peripheral vascular disease, metabolic disease or neurological disease the payer says on its website. However, if you’ve been struggling to collect for these services from TRICARE, you could be treating a patient that doesn’t meet the criteria. The guidelines TRICARE follows are fairly similar to Medicare’s, and it does not cover:

• The removal of corns, calluses and other routine podiatry services
• Nerve blocks for increasing blood supply to the foot and toes
• Shoe inserts
• Orthopedic shoes (unless attached to a brace)
• Arch supports

If your patient falls into this category, chances are that the services will be only available to TRICARE patients on a cash-pay basis, and you should request that the parent sign an advance beneficiary notice (ABN) in these instances.

TRICARE is Usually a Secondary Payer

According to TRICARE’s website: “By law, TRICARE pays after all other health insurance except for Medicaid, TRICARE supplements, state victims of crime compensation programs or other federal government programs.”

TRICARE is almost always considered the secondary insurance when a patient has an additional form of insurance.

It’s import to note that the exception TRICARE mentions is for Medicaid, not Medicare. If you see a Medicare patient who also has TRICARE, you should submit the claim to Medicare first, and then the balance bill can go to TRICARE. If, however, the patient has both Medicaid and TRICARE, bill TRICARE first, and then file with Medicaid.

File TRICARE as Soon as Possible

In the case of TRICARE, you only have a year from the date of service, or a year from the discharge date for inpatients. After that, the claim will be denied.

Your practice most likely files claims on the date of service, but practices often find claims that haven’t been filed during audits or record reviews. In these cases you may want to send in claims later than usual, but for TRICARE you need to keep that year mark in mind.

Unlisted Codes on TRICARE Claims Need to be Described

TRICARE isn’t very keen on paying claims with unlisted or unspecified codes, much like your other payers. If you submit a claim with an unlisted service code on it, you should also submit “supporting documentation describing the services rendered or the claim will be returned or denied for this information,” says HealthNet Federal Services, the claims processing partner for TRICARE’s Northern Region.

To read further in depth about this topic, visit www.hnfs.com/content/dam/hnfs/tn/prov/resources/pdf/2015_QRC_Claims_Billing.pdf.

For more on TRICARE filing tips, visit www.TRICARE.mil/Resources/Claims/MedicalClaims/FilingTips.aspx.