Dermatology Year-End Billing Challenges: Why Revenue Drops and How Outsourcing Protects Practices

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Top Year-End Billing Pain Points Dermatology practices face some of the most complicated coding and reimbursement issues at the end of the year. Seasonal appointment spikes put additional pressure on billing teams struggling with: Declining reimbursements for common procedures such as biopsies, lesion excisions, cryotherapy, and Mohs services Payer-to-payer coding variability, especially on pathology-linked services Bundling disputes where multiple procedures performed in the same session are denied due to improper modifier usage Cosmetic vs. medical necessity confusion, leading to denials when documentation doesn’t clearly justify why a lesion needed removal Increased scrutiny on skin cancer—related services due to rising utilization These persistent challenges often leave dermatologists with more unpaid claims, lost revenue, and rising patient AR at year-end. What Practices Are Doing Right Now To reduce claim rejections before the year ends, most dermatology practices are: Re-trainin...
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Basics of Medicare Consolidated Billing for SNFs

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Need for Consolidated Billing for SNFs

Prior to the Balanced Budget Act of 1997 (BBA), a Skilled Nursing Facility (SNF) could elect to furnish services to a resident in a covered Part A stay, either, directly using its own resources; through the SNF's transfer agreement hospital; or under arrangements with an independent therapist (for physical, occupational, and speech therapy services). In each of these circumstances, the SNF billed Medicare Part A for the services.

However, the SNF also had the further option of ‘unbundling’ a service altogether; that is, the SNF could permit an outside supplier to furnish the service directly to the resident, and the outside supplier would submit a bill to Medicare Part B, without any involvement of the SNF itself.

This practice created several problems, including the following:

  • Potential for duplicate (Parts A/B) billing if both the SNF and outside supplier billed;
  • An increased out-of-pocket liability incurred by the beneficiary for the Part B deductible and coinsurance even if only the supplier billed; and
  • A dispersal of responsibility for resident care among various outside suppliers adversely affected quality (coordination of care) and program integrity

Then Balanced Budget Act of 1997 (BBA), was enacted, containing a Consolidated Billing (CB) requirement for SNFs. Under the CB requirement, an SNF itself must submit all Medicare claims for the services that its residents receive. Conceptually, SNF CB resembles the bundling requirement for inpatient hospital services that's been in effect since the early 1980s, assigning to the facility itself the Medicare billing responsibility for virtually the entire package of services that a facility resident receives, except for certain services that are specifically excluded.

To get more information about Medicare Consolidated Billing for SNFs click here: https://bit.ly/3vmPAjQ. Get in touch with us at: info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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