15 SOPs That Protect the Most Revenue in a Podiatry Practice

In most practices, a small number of operational processes control the majority of revenue. If those workflows are inconsistent, practices can lose 15% or more of collectible revenue through denials, missed charges, or uncollected patient balances.

1. Insurance Verification (Pre-Visit-not when the patient arrives)

This is the single most important revenue SOP.

Staff should verify:

• Active coverage (at every visit for all patients)
• Specialist copay (for all new patients and the first time an existing patient is seen in the new calendar year)
• Deductible status (see above)
• Referral requirements (see above)
• Prior authorization requirements (see above)

Most front desk issues and claim denials start here.

2. Prior Authorization Workflow 

Services that often require authorization:

• Surgery
• Advanced imaging
• Custom orthotics (some plans)
• Certain DME (custom 

3. Referral Management

For most HMO plans verify:

• Valid referral
• Correct provider
• Valid date range
• Number of authorized visits

Missing referrals frequently result in non-payable claims.

4. Copay Collection at Check-In

Collect copays BEFORE the patient is roomed 

Practices that collect at checkout often see:

• Patients leaving early without paying
• Increased billing costs 
• Lower collection rates

5. Patient Balance Collection Policy

Balances should be addressed before the patient is seen whenever possible.

Recommended workflow:

1. Check balance during appointment confirmation
2. Inform patient before visit of balances higher than $25 (or pick a number you are comfortable with)
3. Collect at check-in along with the copay (start with a clean slate)

6. Charge Entry Procedure

Every visit should be reviewed for:

• Correct CPT codes
• Correct ICD-10 codes linked correctly to CPT codes 
• Appropriate modifiers 

7. Modifier Usage for Procedures

Incorrect modifiers cause denials.

As you know, these include:

• -25 (E/M with procedure)
• -59 (distinct procedure)
• TA–T9 (toe modifiers)
• -RT / -LT

8. Claim Submission Timeline

Claims should be submitted within 24–48 hours after the visit. This means your notes should be completed in the same timeframe.

Delays create:

• Cash flow problems
• Missed timely filing deadlines (you still have 12 months for Medicare but private insurance timely filing deadlines can be as little as 60 days)

9. Claim Scrubbing Process

Before claims are sent, systems or staff should review for:

• Missing modifiers
• Diagnosis mismatch
• Insurance information errors
• Missing information such as DLS for Medicare RFC claims (with Q modifier used)

10. Denial Management

Denied claims should be worked weekly, not monthly.

An SOP should define:

• Denial categories
• Appeal process
• Resubmission procedure:
• How these are being tracked (see below)

11. Accounts Receivable Follow-Up

Insurance claims older than 30 days should be reviewed by tracking:

• Aging reports
• High-value claims
• Underpayments (according to allowed amounts as per your fee schedule)

12. Patient Statement Workflow

Statements should be sent:

1. Immediately after insurance processing
2. Monthly thereafter
3. Bi-monthly statements can also be implemented to decrease clinic call volume following statement release (with billing questions) 

Include clear payment options including the ability to pay through your website.

13. Payment Plan Policy

Only for large balances, practices should offer:

• Structured payment plans
• Credit card on file options

Without a policy, many balances go unpaid.

14. Collection Agency Referral Process -I am not personally a fan of collection agencies but sometimes it’s necessary 

Balances typically move to collections after 90–120 days. 

The SOP should include:

• Notification timeline
• Minimum balance threshold
• Agency referral process

15. DME & Ancillary Service Billing

Podiatry practices often lose revenue due to poor processes around:

• Custom orthotics
• Diabetic shoes
• Bracing

These services require very specific documentation (available in the Pinnacle resource library) and billing steps (if your billing company or biller is not experienced in DME, this could cause major revenue loss). 

Stay tuned… we are just getting started!