What Clean Claim Rate Should a Dermatology Billing Partner Actually Guarantee You?

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Choosing a dermatology billing partner based only on a promised clean claim rate can be misleading. A billing company may tell you that it maintains a 95%, 97%, or even 99% clean claim rate. But before accepting that number, you need to know how the rate is measured, what claims are included, and whether those clean claims are actually being paid correctly . For dermatology practices, this matters because a claim can pass an initial billing check and still face problems related to medical necessity, modifiers, procedure coding, payer policies, or underpayment. A clean claim rate should therefore be viewed as one part of the revenue cycle, not the entire performance picture. What Clean Claim Rate Should a Dermatology Billing Partner Guarantee? A reasonable contract target is 97% or higher , provided the billing partner clearly defines the metric and measures it consistently at the payer level. The percentage itself, however, is only part of the agreement. A dermatology practice should a...
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Are you correctly Using 99291 and 99292 codes?

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Critical care is the direct delivery by a physician(s) of medical care for a critically sick or injured patient. 

  • The care of such patients involves decision making of high complexity to assess, manipulate, and uphold central nervous system failure, circulatory failure, stun like conditions, renal, hepatic, metabolic, or respiratory failure, postoperative complications, overwhelming infection, or other fundamental system capacities to treat single or multiple indispensable organ system failure or to prevent further deterioration. 
  • It may require extensive interpretation of multiple databases and the use of advanced technology to manage the patient. 
  • Critical care services include yet are not limited to, the treatment or prevention of further deterioration of the central nervous system failure, circulatory failure, stun-like conditions, renal, hepatic, metabolic, or respiratory failure, postoperative complications, or overwhelming infection. 

To reliably and consistently determine that delivery of critical care services rather than other evaluation and management (E/M) services is medically necessary, both of the accompanying medical review criteria must be met notwithstanding the Current Procedural Terminology (CPT) Manual definitions: 

  • Clinical condition criterion – There is a high likelihood of sudden, clinically huge, or life-threatening deterioration in the patient's condition which requires the highest level of physician preparedness to intervene urgently. 
  • Treatment criterion – Critical care services require direct personal management by the physician. They are life and organ supporting interventions that require frequent, personal assessment and manipulation by the physician. Withdrawal of, or failure to initiate these interventions on an urgent premise would likely result in sudden, clinically huge, or life-threatening deterioration in the patient's condition. 

Reporting Critical Care Services 

CPT code 99291 (evaluation and management of the critically sick or critically injured patient, initial 30-74 minutes) to report the initial 30-74 minutes of critical care on a given calendar date of service. You can just use this code once per calendar date to charge for care provided for a specific patient by the same physician or physician gathering of the same specialty. 

CPT code 99292 (critical care, each extra 30 minutes) is used to report extra block(s) of time, of as long as 30 minutes each beyond the initial 74 minutes of critical care. Critical care of fewer than 30 minutes all outspan on a given calendar date isn't reported separately utilizing the critical care codes. This service ought to be reported utilizing another appropriate E/M code, for example, subsequent emergency clinic care. 

Whether it's utilizing correct CPT codes or documenting medical necessity or documenting time, critical care billing and coding are challenging assignments. Partnering with an experienced critical care medical billing service provider is a useful method to ensure accurate reporting and avoid audits. To find out about our critical billing and coding services, get in touch with us at can reach us at 888-357-3226/info@medicalbillersandcoders.com

Location: 108 W 13th St, Wilmington, DE 19801, USA

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