For dermatologists, there's a topic that other specialists don't have to consider as often: the distinction between covered and uninsured patient pay medical services. Some procedures are covered. Others are cosmetic. Even others can be both based upon the indication. The key to dermatology's medical billing game is knowing when to use cosmetic, and when to use medical.

The Medical Versus Cosmetic Split in Dermatology Medical Billing

If a patient has a lesion removed because it is potentially harmful, then it's covered. If the patient has it removed because it is unsightly, it isn't. Medical dermatology billing needs to clearly reflect which side of the line it is and the paperwork needs to back up the claims. Payers want to see it documented, and if it isn't, the claim will be denied.

But often medical and cosmetic services are rendered in the same dermatology encounter. For example, the patient may have a lesion removed to prevent it from becoming cancerous and another removed to improve the appearance of the skin. Dermatology Medical Billing must document the services appropriately, submit for insurance payment a service it has to fund and deal with a self-pay service. Combining them results in denials and appeals to work through.

Lesion and Biopsy Coding in Dermatology Medical Billing

When it comes to coding lesion removals in dermatology medical billing, the lesion size, type of removal and location matter. They are not equivalent items. Removal of a two-centimeter lesion on the back via a shave biopsy is different from removal of a two-centimeter lesion on the face using an excision. These details are captured through documentation which gives the nature, size and technique of the procedure performed, rather than just a summary.

Biopsy coding is another consideration. If more than one biopsy is taken, the main code applies to the first site, and there's an add-on code to bill for each additional site. Dermatology medical billing teams that forget to code the additional sites miss a valuable opportunity to bill a multi-site biopsy properly. When there are multiple biopsy patients a week, this is a significant loss of revenue.

Mohs Surgery Documentation in Dermatology Medical Billing

Mohs surgery documentation must be staged to include documentation for each layer of skin removed, every margin cleared, and every pathology review. Each step is billable, and documentation must provide support for each step. Incomplete documentation for Mohs dermatology medical billing is a typical cause of complication and denial of high-value surgery claims when they are reviewed by payers.

Med Brigade Services: What a Full-Service Billing Partner Actually Delivers

Many billing service companies claim to offer revenue cycle management. Med Brigade Services include everything from the start of the process verifying a patient's insurance prior to an appointment to the end when the patient's outstanding balance clears. There's no in the middle that's left up to chance or is the client's responsibility.

The Core of What Med Brigade Services Include

Med Brigade services begin with eligibility and benefits verification, so there's no surprise about what services might be covered by a patient's insurance plan before services are rendered. We take advantage of certified coders to enter charges and review coding to ensure all charges are appropriately classified and meet customer requirements. Submissions are clean from the start, and that eliminates denials, and it gets paid quicker.

If there are denials, Med Brigade services include an AR/denial management team that processes them in a step-by-step fashion. Timely and appropriate appeals are filed, the proper follow-up is conducted, and no case goes past the deadline for filing appeals without diligent action. Payments are posted daily so accounts remain up-to-date and reports represent real-time success in collections.

Reporting and Account Management Within Med Brigade Services

All clients have an account manager within Med Brigade services. So, there's one contact for practice management troubleshooting who knows the practice and its payer mix and can answer questions without having to delve into their practice's situation. Regular reports - daily, weekly and monthly, provide insight on collections and denials, and overdue balance.

Med Brigade's services also include credentialing and enrollment support for practices that need to get providers credentialed with new payers or to update existing credential information. Whether it's federal insurance 30-60 days out or commercial insurance credentialing or CAQH updates, we provide the same care in managing provider enrollment as we do manage billing.

Specialist Billing and a Partner You Can Actually Rely On

Dermatology medical billing is a type of specialty billing that can avoid mistakes before they occur. Med Brigade services take the same expertise to account and case management, reporting and revenue cycle support that help practices get more revenue. The simple message is working hard for your practice.