Dermatologists play a critical role in reducing the burden of skin cancer, preventing both death and morbidity but its billing is challenging. The healthcare sector in the US is changing rapidly and the smart dermatologist acting proactively to get familiar with changing needs of dermatology medical billing. It is a complex process due to all its paperwork and extensive documentation hence it is advisable to optimize your practice’s administrative efforts to save time and cost. But how would you do that?
In this article, you will get more insight into dermatology medical billing challenges and tips which help to streamline your billing process beforehand.
Accurate medical billing documentation is required for many reasons like acting as a legal document that will prove the services rendered, as well as why those services were rendered and/or why the patient was seen by the provider. The documentation may also serve as evidence in a court of law. Moreover, it is important for accurate reimbursement for performed procedures.
The use of modifiers is not well understood and hence 59 modifier are used excessively. Many have struggled with the issue of medical documentation and the use of modifiers with E/M and dermatology procedure codes.
Coding systems are an indication of procedures performed by physicians after the patient encounter and insurance companies provide reimbursement based on these coding systems. Generally, providers prefer to use The International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes.
ICD-10-CM is the standard transaction code set for diagnostic purposes under the Health Insurance Portability and Accountability Act (HIPAA). It is used to track health care statistics/disease burden, quality outcomes, mortality statistics, and billing. ICD-10 diagnosis codes are much more detailed are typically 3 to 7 characters in length and begin with an alpha character.
All types of inpatient and outpatient procedures and services are indicated with the Current Procedural Terminology (CPT). Dermatology practices use many of these codes to bill for in-office procedures like skin biopsies, destructions, excisions, and Mohs surgery. Within the CPT coding system are the Evaluation and Management (E/M) codes, which are used to appropriately bill for the level of an office visit or inpatient visit.
As we have seen earlier lack of billing knowledge will lead to overuse of modifier 25 and modifier 59. Where the 25 modifier are defined as “significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service.” While modifier 59 is defined as Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day.
CMS and other payers constantly scrutinizing these modifiers are used by physicians as well as any case of overpayment. According to an article in Dermatology Times, approximately 60% of E/M services performed by dermatologists are submitted with modifier 25 attached, compared to about 25% “for the rest of medicine.” This means that any change in modifier 25 payment policy will affect dermatology more than other specialties.
Many dermatologists are facing challenges in collecting the latest insurance information from their patients. However, the administrative team gets in touch with the correct and current insurance provider to avoid any kind of claim denials. Taking the time before providing services to double-check insurance information can save your practice months of unpaid claims time.
Full reimbursement from the payer is challenging hence timely claim submission can increase chances of full reimbursement. You should make it a priority for your back office to file claims daily to improve your clean claims ratio.
You should have a mechanism to determine in advance the co-pay each patient owes you at the time of service. Moreover, you should establish it as an official policy to collect in advance. Have your front desk staff escalate any issues with patients who regularly refuse to pay up.
Most frequent patients are reluctant to share information and hand over their insurance cards every time they come in. But you need to check patient insurance information every time to check if it has any updation which is the only way to make sure that you handle things appropriately with their insurer.
You should keep track of submitted claims which helps you to know “what you’re not being paid for” and “what you’re being paid”. If a claim takes longer than sixty days to be paid, follow up before you resubmit. Sometimes all it takes to get your claim handled by a payer is a phone call.
Now, you are very clear about various dermatology medical billing challenges and tips to overcome some of the challenges and streamline your practice. If you are still facing any issues, then you can get in touch with us. We are a team of expert coders to help you out and boost your dermatology revenue.