As we talk to Dermatologists across the country, revenue pressure is consistently identified as one of the most challenging aspects of running an independent Dermatology practice today. For many independent Dermatology practices, revenue pressure is caused by flat or declining Medicare and health insurance company reimbursement rates.
Effective Dermatology billing is a critical component that supports the smooth functioning of medical offices while protecting the well-being of patients.
Dermatology billing errors can lead to misunderstandings, delayed treatments, and unforeseen financial consequences for patients. Meanwhile, improper billing may result in income loss, ruined reputations, and even legal issues for medical practices.
Importance of Accurate Dermatology Billing and Coding
Does your Dermatology practice have trouble keeping up with medical billing?
Or do you have a high percentage of denied claims?
Dermatology practices offer a wide range of procedures, some of which are covered by insurance and some of which are not. As you are aware, filing insurance claims and collecting patients' out-of-pocket expenses can complicate the billing process.
Dermatology medical billing might have been difficult for a dermatological clinic to grasp, but it is not impossible. You can be better prepared to face issues after you grasp the most prevalent ones and the best billing procedures.
You might also be thinking if it is preferable to outsource dermatological billing services to a third-party firm or maintain this important duty in-house in order to combine specialized patient care with maximum reimbursements to protect the financial health of your dermatology practice.
While outsourcing coding and billing to an experienced and knowledgeable coding and billing company is definitely appreciated, dermatologists have to document their services using the correct terminology to ensure that the right codes are used.
Top Challenges in Dermatology Billing and Coding
Accurate medical billing is critical in Dermatology for various reasons. It is difficult to obtain reimbursement for dermatological treatments provided for a variety of reasons. The variety of procedures involves many codes, as well as the possibility of errors too.
Dermatology billing necessitates precise documentation in order to reduce administrative costs and time. There is an absolute need for proper knowledge regarding Dermatology coding and how to apply modifiers to dermatological procedure codes.
Dermatologists should not only be receptive in understanding skin issues and assisting patients with both cosmetic and medical decisions, but they must also guarantee that billing is done appropriately.
Here comes the top Dermatology billing and coding challenges you need to be aware of:
Regulations that are complex and constantly changing
In general, dermatological operations considered medically necessary are covered by insurance, whereas elective and cosmetic procedures are the financial responsibility of the patient. Though it seems straightforward, there are gray areas within this framework, in the case of procedures such as removing a mole.
To make things even more complicated, the rules keep changing, and it's up to the office's medical biller to stay up-to-date, especially with medical coding. In addition to changes and updates to coding, there could also be new regulations that must be adhered to at the state and local level.
High Volume of Claims
Having a busy dermatology practice means submitting a lot of insurance claims. Prior to recommending a treatment plan or performing a procedure, check the patient's insurance coverage to streamline the claim process.
Further, documenting everything thoroughly and promptly can save you time later. Instead of searching for documents or patient information, you'll have everything you need to finish the claims and billing process right at your fingertips.
High Risk of Denials
There are a variety of factors that can lead to a denial of payment by insurance companies, including:
Failure to follow medical coding guidelinesHaving a surgery performed that was not covered by insuranceLate submission of codes (including dermatology CPT codes)Incomplete credentialing servicesUsing an out-of-date dermatological modification (always double-check each modifier before filing a claim)
As you can imagine, having even one claim refused may be devastating to your dermatological practice's revenue. When claim denials become commonplace, the consequences can be disastrous. A major stumbling block for a dermatology medical billing service provider is a modifier intended for existing patients rather than new patients to the clinic.
A successful claims ratio of 95% is a dermatology industry standard. Anything less than this amount is thought to imply a considerable income loss, not only the claim denials but also the time your staff and dermatological medical billing services team must spend reworking the claims.
Dermatology Medical Billing Guidelines – All You Need to Know
Dermatology billers and coders must understand the principles of skin-related diagnoses, such as the distinction between benign and malignant tumors.
They also need to understand how simple, intermediate, and complicated are differentiated, in addition to terminology for size like length, depth, breadth, and circumference.
Medical coders and billers specifically for the dermatology specialization must understand the distinction between cosmetic and medical dermatology. Medical dermatology services are medically necessary to treat certain conditions and diseases. On the other hand, cosmetic dermatology procedures enhance skin appearance without being considered as medically necessary.
While cosmetic dermatology procedures are charged directly to patients, medically required dermatological services are often reimbursed by insurance. Some services, including the excision of moles, may fit under both categories.
Medical coders in these situations must first decide if the dermatological operation is medically necessary. Then, each method or service must be converted into industry-recognized alphanumeric codes by billers and coders.
Here are common guidelines that could be kept in mind while billing and coding for Dermatology.
Submitting Clean Claims on Time: If your clean claim rate is less than 95%, it suggests your Dermatology practice is losing money. Insurance companies have claim filing deadlines that billers must adhere to in order to file claims on time.
Ensuring Complete and Accurate Documentation: The billing staff should verify that all documentation pertaining to the patient's care is complete. Accurate and thorough documentation is beneficial for insurance reimbursement and regulatory agency compliance audits.
Using Right CPT Codes and Modifiers: For accurate medical coding, an in-depth understanding of the right CPT and ICD-10 codes and modifiers is required. CPT Coding rules and modifiers are always changing, therefore, you must stay up-to-date on any changes.
Staying Current with Regulations: Changes to ICD-10 and CPT codes, as well as federal and state restrictions, can have a significant influence on medical billing. It is critical to be informed about these issues and to maintain compliance in order to prevent reimbursement delays.
Verifying Insurance Coverage: Before offering any services, dermatologists should confirm the patient's insurance eligibility and coverage. By doing this, clinicians can figure out whether patients will incur out-of-pocket costs and stay away from any billing surprises.
Technology Usage: From electronic health record (EHR) systems to medical billing software, there are several technologies available today to help expedite the medical billing process. This significantly reduces time spent on billing while also increasing billing accuracy.
Outsourcing Dermatology Billing
Because of the complexities of medical billing in Dermatology, it can be difficult for Dermatologist to comply with billing requirements and secure optimum reimbursement. Dermatologists may optimize their billing operations and free up their internal resources from administrative burdens by working with an efficient Dermatology billing partner.
Here are some of the pivotal benefits you’ll experience when you outsource your Dermatology medical billing:
Outsourcing reduces billing errorsImproves cash flow and revenueLowers operational costEnhanced Reimbursement Rate and RevenueMinimizes denialsAllows you to focus more on patient careProvides staffing consistencyImproves patient satisfaction
Optimize Your Dermatology Practice Revenue
As dermatologists, you play a vital role in providing excellent patient care. However, it is as crucial to guarantee that your dermatological practice runs smoothly and profitably.
You may attain financial success and maintain a profitable dermatological practice by mastering the best practices listed below.
Here's to healthy skin and a healthy bottom line!
Accurate and Comprehensive DocumentationKeep Up-To-Date Coding GuidelinesTimely and Accurate Claim SubmissionEnsure that Medical Necessity is Properly DocumentedAdopt Stable Revenue Cycle Management (RCM) TechniquesConsistently keep an eye on key performance indicators (KPIs)Maintain Compliance with Regulations
Achieving financial excellence in the field of Dermatology is all about finding that perfect balance between providing top-notch patient care, and managing your practice's finances effectively.
Implementing the best practices discussed in this blog, say, accurate documentation, staying current on coding guidelines, optimizing claim submission, emphasizing medical necessity, robust revenue cycle management, monitoring KPIs, and maintaining compliance will position your dermatology practice for long-term growth and profitability.
On the whole, prioritizing your financial health alongside patient care, and you'll be well on your way to establishing a profitable dermatological practice that can withstand the ever-changing healthcare landscape. Here's to healthy skin and a healthy bottom line!
BillingMD360 is a scalable solution that helps improve the dermatology medical billing process to increase revenue while freeing up staff time for better patient care.
To see how BillingMD360 can replace your current dermatology billing service, schedule a demo today.