Do constant billing adjustments prevent your dermatology practice from making its worth?

Dermatology is one of the booming healthcare practices that survive both as a part of a larger hospital setup and as private practices and dermatology medical billing and coding teams have to always be on their feet, quick to think and act if they want to help their clients grow financially.

The need for dermatologists has increased in the United States in the last few years, thanks to demanding invasive and non-invasive dermatological and cosmetological procedures. As a dermatologist, a doctor’s primary goal would be to help patients feel better and get the right treatment.

However, as a private practitioner, a doctor should also be worrying about things like cash flow, revenue, and adjustments to ensure they stay in business and offer world-class service to their patients.

An adjustment is done when the billing team decides to write off a particular bill for some reason. It could be because of an agreement with the insurance provider because the value is really low and not worth following up on, or because of billing errors. How often a medical billing and coding team makes adjustments is one way to check the effectiveness of the team. Bills should not be adjusted just because the team ended up making errors in filling up details and inputting codes or processing bills very late.

Did you know that Dermatologists spend an average of 15 hours a week on administrative and billing work? That’s why a professional medical billing and coding team will be able to handle billing and coding requirements, helping practices collect the right fees that they are worth, without having to resort to frequent and loss-causing adjustments. While doctors are already struggling with insane work hours and burnouts, handling backend issues like claims rejection, increasing billing adjustments, and denials could tip them over the edge.

It makes sense to let experts do their jobs. While doctors are responsible for the treatment processes, a medical billing and coding team should be taking over the task of improving revenues, reducing rejection rates, and ensuring bills are collected timely.

Why do dermatology bills get rejected or denied?

There could be three major reasons why these dermatology bills could get rejected or denied when they are submitted. Handling these three issues right can drastically improve revenues in a short span of time.

  • Constant changes in compliances

One major problem that experts in the medical billing and coding industry face is having to constantly deal with changes in regulatory compliances. The knowledge that a biller or a coder has in this field is not something they can take for granted. The International Classification of Diseases (ICD) codes and the Current Procedural Terminology (CPT) codes are commonly used codes in the industry. These, unfortunately, keep changes/updating.

Unless your biller and coder know the latest regulatory compliances, there are chances the bills get denied due to insufficient information or wrong codes. It would be better for such clinics and practices to trust established medical billing and coding brands that keep themselves updated with the latest changes and invest considerably in training their employees regularly.

  • The complexities of modifiers

Apart from these codes, the billers and coders also have to use medical coding modifiers that are appended to the initial codes to provide additional information about the procedure/treatment. Payers (insurance providers, in most cases) scrutinize these modifiers and are quick to pounce on them if they are overused, underused, or used to bill for more than the allowed value.

As a result, medical billing and coding experts have to take care of the modifiers that they use every single time. Not using a modifier can lead to rejections. Using a modifier where it was not needed can lead to unwanted scrutinization of the bill and an eventual possibility of denial.

One of the top denials in Dermatology is CO-97 which is when a claim is denied as inclusive/Bundled. Here are some examples where the use of the correct modifier will avoid this denial.

  • When we bill CPTs 17000* and 17262* together we need to add 79 modifier to CPT-17262* and 51, 79, and 59 modifier to CPT-17000*
  • When we bill 12031* and 11601* together, we need to add 79 Modifier to CPT-12031* & 51, and 79 modifier to CPT-11601*
  • When we bill 17000* and 17003* together, we need to add 51/79/59 Modifier to CPT-17000 & 51, 79 modifier to CPT-17003*
  • When we bill 17004* and 11307* together, we need to add 79/59 Modifier to CPT-17004* & 79 modifiers to CPT-11307*

Payers look for these modifiers with a magnifying lens and claims that are not billed with these appropriate modifiers will be quickly denied. Unless your medical billing and coding expert understands these modifiers well, you can expect a consistently high denials rate for your billing practice.

  • Documentation issues

Inadequate documentation is a recurring challenge in the healthcare industry, leading to high levels of claim rejections across different sectors. Dermatology is no different. Every evaluation procedure will need a check of the history of the patient, a physical examination, and decision-making. At every stage, the level of service will be different. Unless the service details are documented right, billers will not be able to comprehend the levels of service.

As per the 2021 Coding and Documentation guideline from the American Medical Association, providers can now spend less time on code selection and documentation and more time on patient care. A complex procedure may be billed low as a mere examination or vice versa. For Example, A history of skin cancer is classified as a minor condition because it is history and is not considered a chronic condition, hence it cannot be used to meet two out of the three of the medical decision-making category to bill 99214*.

Documentation is the basis on which services have to be billed and this involves coordination with the examiners, the nurses, and several back-end teams. Unless your medical billing and coding team comes with decades of experience like Quintessence, it may not be able to keep up with this.

Did you know that all our clients get to use our free Doctor’s Portal, a solution that helps quickly reach out to the doctor for billing queries so bills can be comprehensive and rightly created? This way, communication is channelized, and our clients will be able to identify information bottlenecks quickly, avoiding delays in billing.

The Quintessence Difference!

Quintessence is a perfect RCM partner for medical billing and coding companies, to handle your RCM needs fuss-free. With handling over 55,900 patient visits accounting to over $21.5 Million charges in dermatology and with a clean claim rate of over 97%, Quintessence is backed up by our solutions along with unmatched human expertise and technological prowess. With four delivery centers, three in India and one in the United States, we have all that it needs to handle healthcare RCM like a pro.

Are you a large or independent dermatological practice wanting to offer uninterrupted care services to your patients? Quintessence can be the strategic difference that you need to stride forward. Is aggressive growth on your mind? Do you struggle with unpredictable billing and coding volumes? Is your existing cost squeezing out your profits? Outsourcing could be the answer and Quintessence could be just what you need.

Get in touch with us to know all about the Quintessence advantage and how you could bank on it.

(*) 17000 – Under Destruction Procedures on Benign or Premalignant Lesions of the Integumentary System
17262 – Under Destruction Procedures on Malignant Lesions of the Integumentary System
12031 – Under Repair-Intermediate Procedures on the Integumentary System
11601 – Under Excision-Malignant Lesions Procedures on the Skin
17003 – Under Destruction Procedures on Benign or Premalignant Lesions of the Integumentary System
17004 – Under Destruction Procedures on Benign or Premalignant Lesions of the Integumentary System
11307 – Under Shaving of Epidermal or Dermal Lesions Procedures
99214 – Established patient office or other outpatient visit, 30-39 minutes.

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