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Dermatology Medical Billing Challenges and Tips to Increase Revenue



Dermatology Billing Services

The role of dermatologists is crucial in decreasing the incidence of skin cancer and preventing deaths and complications, but their billing is difficult. The health care industry is in the US is rapidly changing and the most effective dermatologists are acting actively to become familiar with the ever-changing requirements for the dermatology medical billing. It’s a difficult process because of all the documents and paperwork. Therefore, it is recommended to maximize the administrative processes of your practice to cut down on time and expense. What can you do to do this?

In this article, you’ll learn more about the Dermatology billing services and their issues for dermatologists and suggestions to make your billing process easier prior to the time of billing.

Dermatology Medical Billing Challenges:

Documentation Challenges

Medical billing documents that are accurate are essential for a variety of reasons, including being an official document to document the services provided and the reason the services were provided or why the patient was referred to the medical professional. Documentation can also serve as evidence in legal court. Additionally, it is essential to ensure that you receive a fair reimbursement for the procedures.

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Modifiers’ use is not widely understood and, as such, the use of 59 modifiers is excessive. Many have had to deal with the problem of medical documentation and modification that include dermatology procedures codes and E/M codes.

Different systems of coding

Coding systems provide a record of the procedures that physicians perform after a consultation with a patient. insurance companies pay reimbursement based on these systems. Most providers prefer using The International Classification of Diseases (ICD) and the current Procedural Terminology (CPT) codes.

ICD-10-CM is the most commonly used transaction code used for diagnosing reasons under Health Insurance Portability and Accountability Act (HIPAA). It’s used to monitor the burden of health care and quality outcomes, as well as mortality statistics as well as billing. ICD-10 diagnose codes, which are more specific and are usually three to seven characters long, and begin with an alpha.

All types of inpatients as well as outpatient procedures and procedures are identified by the current Procedural Terminology (CPT). Dermatology practices employ numerous of these codes in order to bill for procedures performed in the office, such as skin biopsies and destructions, Mohs surgeries, and excisions. Within the CPT code system there are Evaluation and Management (E/M) codes that are used to bill appropriately for the cost that an office or inpatient appointment.

Dermatology Medical Billing Compliance

As we’ve observed previously, inadequate knowledge of billing practices can result in the excessive use of modifier 25 and modifier 59. The 25 modifiers are described by the term “significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service.” Modifier 59 is described as Distinct Procedural Services under certain conditions it could be necessary to show that a procedure or procedure was distinct from or different from other non-E/M procedures performed on the same day.

CMS as well as other insurers are keep reviewing these modifiers by physicians, as in any instance of overpayment. In a report published in Dermatology Times, approximately 60 percent of E/M treatments provided by dermatologists are reported to CMS with modifier 25 as opposed to 25percent “for the rest of medicine.” This implies that any changes in modifier 25’s payment policy can affect dermatology more than other areas of expertise.

Information about patients that is out of date

A lot of dermatologists are having difficulties in obtaining the most current details about their insurance from patients. But the administrative team stays in touch with the current and correct insurance company to prevent any type of denial to claim. Making the effort prior to offering services to check the information on your insurance policy could save the practice of waiting for months to pay claims time.

Now, Let’s look at Dermatology Medical Billing Tips:

Late claim submission

The full payment from the payor can be a challenge therefore timely submission of claims could improve the chances of receiving full reimbursement. It should be the top priority of your back office to submit claims every day to improve the ratio of clean claims.

Collect Co-Pays at Time of Service

There should be a way to establish the amount of co-payment each patient owes at the moment of their service. Furthermore, you should make it as a policy to collect prior to the time of service. The front desk personnel should take action on any complaints from patients who frequently refuse to pay.

Update & Verify Patient Insurance

Patients who are frequent visitors are less likely to divulge information or provide their insurance card each time they visit. However, you must check the insurance details of your patient every single time to determine whether there is any update that can be the sole way to be sure that you are dealing properly with their insurance provider.

Track & Follow-Up on Unpaid Claims

It is important to keep records of claims you’ve submitted which will allow you to determine “what you’re not being paid for” and “what you’re being paid”. If a claim is taking more than sixty days before it is paid, be sure to follow your progress before submitting a new claim. In some cases, all you have to do to have your claim processed by a payor is a call.