“Tackle the Challenges of Dermatology medical billing with clarity and precision to improve your revenue cycle management”
Skin is the largest organ of the integumentary system, covering the human body.
Dermatology deals with the skin, its structure, functions, and ailments. The fact that the skin is the largest human organ indicates the wide scope of dermatology. As a result, dermatologists have a multitude of procedures and treatments under their umbrella.
Due to this, managing medical responsibilities along with administrative tasks becomes a hassle and leads to stress. Along with that, dermatology medical billing comes with numerous complexities that increase the chances of errors. In the longer run, negligence of medical billing can cause revenue loss and financial instability.
This blog is the ultimate guide to dermatology medical billing. By the end of this blog, you will have a clear overview of medical billing steps, challenges and ways to tackle them.
Defining Dermatology Medical Billing
Dermatology medical billing is a process of getting reimbursement for the services provided by dermatologists to their patients. The process involves various steps for claim submission and processing.
The process starts when a patient visits the dermatologist where all the relevant information is recorded. The collected data is then translated into codes for claim filing. Once the claims get submitted to the insurance company, they are processed, and revenue is received.
Sometimes, claims get denied, and then follow-up steps are taken to correct errors and resubmit to regain lost revenue. The main goal is to make accurate and timely submissions to avoid revenue delays and leakages.
Key Guidelines of Dermatology Medical Billing
One challenge that enhances the intricacy of dermatology medical billing is the lack of understanding of dermatology terms, procedures, and treatments. It is the responsibility of coders to know the specifics of the specialty such as diagnoses of skin ailments and differences between complex procedure terms.
Some of the common things that medical coders and billers need to know are:
- Different sizing terms such as length, depth, width and circumference
- Difference between cosmetic and medical dermatology
- Difference between simple, intermediate, and complex ailments
There is a major difference between medical and cosmetic dermatology. As the name suggests, medical dermatology involves medically necessary treatment for specific disorders. Whereas cosmetic dermatology involves skin improvement procedures and treatment.
It is vital to know this difference as medical dermatology is eligible for insurance, but cosmetic dermatology is not. For cosmetic procedures, patients make direct payments to the dermatologist.
All this information is essential for medical billers and coders as they need to identify specific codes for procedures. They must do it while avoiding mistakes to prevent revenue losses.
When we talk of coding, there is a bifurcation between two main components, and they are the Current Procedural Terminology (CPT) and the International Classification of Diseases, Tenth Revision (ICD-10) codes. One more component included in CPT is the Evaluation and Management (E/M) Codes.
The Process of Dermatology Medical Billing
This process involves various steps that contribute to a successful revenue cycle management and stability of financial health.
Insurance Eligibility Verification and Prior Authorization
The first step in medical billing is eligibility verification but in dermatology what is even more important is prior authorization. This happens prior to a patient visiting the dermatologist.
In this step, the insurance company gives authorization based on the type of procedure. Insurance coverage is only given in case of medical necessity according to the terms of insurance plan.
Insurance eligibility verification is vital to minimize the risk of claim denials and ensure on-time revenue from the insurance company.
Providing Services and Recording Charges
After the eligibility verification, the second step is attending to the patients and providing services. But it is not limited to this, here all patient data must be recorded without missing any details.
The records include the time of the visit, treatments provided, and other important details of the appointment. Many patients get procedures over the course of time, and this adds to the complexity of billing.
Also, skin ailments may be related to organs which changes the specialty that deals with the treatment. As a result, there is a change in billing and coding requirements as well.
Submission of Claims
The third step is the submission of claims. Basically, the recorded patient information is translated into numerical codes such as CPT and ICD-10 codes.
Medical coders perform this task and carry out claim filing and submit claims to get reimbursement for the services provided. Submitting accurate claims leads to complete reimbursement.
Timely submission is also an important factor in preventing revenue loss and improving the revenue cycle management.
After submission of claims, processing is done by insurance companies. Insurance companies review all the claims and either approve payment or deny it.
When claims get approved, the dermatologist receives payment. In case of denials, there is still a chance for appeals and resubmissions.
Dermatology is one such branch where patients make direct payments for the services. Therefore, they need to optimize their payment collection methods to get proper compensation.
Tracking and Reporting
Medical billing is an ongoing process that affects the continuous flow of operations. Proper tracking and reporting of data gives a clear picture of the practice’s financial status.
What needs to be tracked are services rendered, revenue received, denials & outstanding amounts, and follow-up.
- Missing or Incorrect Codes
- Manual Data Entry
Consider these Points to Simplify Dermatology Medical Billing :
Master the Coding System
To a greater extent, reimbursement depends on the accuracy of codes. This is possible only when you master coding for your specific needs. Your understanding of coding will not only maximize revenue but also reduce overall time spent on administrative procedures. Accurate CPT and ICD-10 codes will prevent errors and reduce the hassle of refiling.
Focus on Eligibility Verification
Getting adequate compensation for services will become challenging if it is not under insurance coverage. Hence, checking for eligibility and not missing any details during patient verification will eliminate the chances in out-of-pocket expenses. This way the process of billing will be much smoother and will lead to positive outcomes.
Maintain Document Accuracy
Maintaining document accuracy means that all the information related to a patient is carefully recorded. This serves as evidence in case of medical necessity and getting revenue for the same. When it comes to cosmetic dermatology, documents help in explaining various charges to the patients.
Following this practice ensures a well-structured action plan for the steps of medical billing. It also ensures timely reimbursement and helps during compliance audits.
Timely Submission of Claims
This is essential as insurance companies usually have deadlines for claim submission, failing to meet the deadline can lead to potential revenue losses. As a dermatologist, you must take care of these deadlines and ensure that you never miss them. It is a challenge with a multitude of patients every day, but prompt submissions help in avoiding revenue leakages.
Stay Current with Regulations
Medical billing is an ever-evolving domain, and in this dynamic environment, it is important to stay up to date with regulations. Staying current with the new regulations and policies directly benefits the financial status of the healthcare practice. It helps in maintaining compliance, avoiding penalties and delays.
Medical billing is an extensive process and handling it manually not only increases the overall burden, but it also creates a chance of human errors. Along with that there is a possibility of manual records being misplaced. On the other hand, technology eases this process and makes data recording effortless with EHR (Electronic Health Records). The advanced tools save time and enhance accuracy which eliminates mistakes.
Partner Up with professional Dermatology Billing Services
It is natural to struggle with the medical billing process as errors and mistakes are inevitable. A better way to let go of this burden is to choose an outsourcing partner to handle dermatology medical billing. Outsourcing partners are medical coding and billing specialists who are capable of handling complexities with specialized solutions. They help in maximizing revenue and reducing your administrative burden so that patient care becomes your sole responsibility.
Dermatology medical billing comes with a lot of intricacies that you can tackle by following guidelines and tips. However, professional services can ease the process and elevate progress.
Unify Healthcare Services is the perfect outsourcing partner for dermatology medical billing. With a team of professionals proficient in dermatology medical billing, you will get maximum reimbursement along with a smooth operational flow. Get best-in-class billing services and achieve the goal of maximum financial stability.