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Dermatology Medical Billing - Challenges and Best Practices

Jul 24

Even though dermatologists provide several medical, surgical and cosmetic services and procedures, getting the appropriate reimbursement can be a challenge.

In a recent dermatology survey conducted by Medscape, most of the respondents reported getting proper reimbursement and adhering to the multiple coding and billing guidelines among the most challenging parts of their profession.

Another study reveals that more than 50% of the dermatologists spend as much as 20 hours a week on paperwork and reporting, compared to just 35% of all physicians.

Dermatology practices are often plagued with denials and even audits. One reason could be the complexities and the ever-changing guidelines associated with the practice. It is common to see dermatologists dealing with a lot of billing and coding errors.

When it comes to reducing costly denials and improving the practice revenue, partnering with a professional medical billing company such as U Control Billing is the best option. We ensure that all patient services are translated to accurate billing and timely reimbursements. 

Read on to get a closer look at some of the most common challenges faced during dermatology medical billing.


Dermatology Healthcare Invoicing Challenges

Inaccurate Documentation

For any medical practice, accurate medical billing documentation is crucial for a number of reasons. For one, the medical document serves as a legal document for the services rendered. The document may also be produced as evidence in a court of law.

Besides, the medical documentation is the basis on which reimbursements are processed for the services provided.

In dermatology, health care providers are often seen struggling with the use of modifiers and other procedural codes. This leads to incorrect documentation and ultimately affects the billing.

Excessive Use of Modifiers

Incomplete knowledge of the coding and billing guidelines most often result in the overuse of modifiers. It is especially the case when it comes to dermatology. According to a report, almost 60% of services provided by dermatologists are assigned the modifier 25. Another modifier that is used excessively is the modifier 59.

The use of the modifier 25 for E/M services is almost the double for what is applied in the rest of the medical industry. Conversely, any changes to the modifier’s payment policy would affect dermatologists more than the other physicians.


Outdated patient information

Getting the recent insurance information from the patients is another challenge for a dermatologist. Outdated or inaccurate insurance information can lead to unpaid claims and months of follow ups.

The administrative team should be tasked before hand to double check the latest insurance information. Taking the time out to get in contact with the relevant insurance provider can also save claim denials.

Late claim submission

A huge reason why dermatologists are unable to get full reimbursement from the payer is the lack of timely claim submission. Unless the back office makes it a priority to file them daily, claims are bound to be submitted late and lead to partial reimbursement.

Co-Pays Collection

It is useful to have a system to collect in advance the co-pay patients owe you at the time of service. Failing to do so results in failure of collection. Practices can establish a policy to collect co-pays in advance to avoid any inconvenience after.

Multiple Coding Systems

Given the various coding systems that are being used in the medical industry, it is common to see physicians getting confused. In dermatology, some practices still continue the use of ICD 9 codes even though it has been years since the ICD 10 came out. It is important to get familiar with the new ICD code set and implement correctly to prevent claim denials.


Common Modifiers in Dermatology

Being one of the more complex specialties in the medical coding and billing scene, dermatology has a wide range of procedures that can be performed. These procedures can either be performed in the office or in the same day surgery setting.

It is crucial, therefore, to have an in-depth understanding of the CPT codes and the commonly used modifiers. This will ultimately lead to accurate coding and timely reimbursements.

Here’s a list of the most common modifiers and their correct usage:

‘25’ Modifier

The CMS defines the 25 modifiers as ‘evaluation and administration services that are significant and individually recognizable that are provided on the exact day as the operation or other treatment by the same doctor’.This makes the 25 modifier one of the most often used modifier and also the most misused one.

It should be noted that the 25 modifier must be employed for existing clients who are associated with the procedure. Avoid using it for other patients and along with new procedure codes.

‘59’ Modifier 

It is among the most improperly used modifiers. To tackle the overuse, CMS issued the X-modifiers as a part of the 59 modifiers. It is commonly used to unbundle codes. Which makes it possible to bill distinct procedures and each claim processed passes the bundling modifications for Medicare.

The X-modifiers also play an important part since they essentially replace the 59 modifiers when applied. Following are some of the X-modifiers:

The X-modifiers comprises of:

XE –a unique service offered through a different encounter. Specifies procedures completed during a similar patient consultation or session..

XU – The assistance that stands out because it rarely overlaps with the primary service or because it's unique

XS – specifies work done on a different place, organ, or system.

XP – a distinctive service delivered by several professionals.


Outsourcing Dermatology Billing and Coding

Given the recent frequent changes in the code sets, the complicated nature of dermatology modifiers and the other challenges discussed above, more and more dermatologists choose to outsource their coding and billing.

Practices prefer professional companies that truly understand the intricacies of dermatology coding and billing. Opting for an outsourcing company that fully understands the procedural rules for CPT codes involved in dermatology is a plus. Also, a full understanding of modifiers and the post-op periods would not hurt either.

Dermatology has expanded beyond providing just medical and surgical services to also providing a range of cosmetic services as well. This means that the revenue that trickles in the practice depends on the kind of billing and coding practices being applied. Outsourcing the process has the ability to prevent claim denials, boost the revenue and reduce audits.

When it comes to choosing the right medical billing company for your dermatology practice, it is important to make the right choice. In the fact-paced environment and the ever-changing rules and guidelines, you need a team of professionals who know their work and the intricacies of dermatology billing and coding. U Control Billing offers nationwide dermatology coding and billing services with a team of professionals to handle the complexities. Reach out to us today to learn how we can become part of your practice.