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

-
Image
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...
Post a Comment

Prior Authorization Exemption for Certain DMEPOS Items

-


On 4th April 2022, CMS published a rule on “suspension of prior authorization requirements for orthoses prescribed and furnished urgently or under special circumstances”. Prior authorization helps Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers ensure that applicable Medicare coverage, payment, and coding rules are met before DMEPOS items are delivered. The prior authorization program helps to protect the Medicare Trust Fund from improper payments while ensuring that beneficiaries can receive the DMEPOS items they need in a timely manner.

CMS maintains a master list of DMEPOS items that requires either a face-to-face encounter and written order or prior authorization requirements. You will find the updated list here. Due to the need for certain patients to receive an orthoses item that may otherwise be subject to prior authorization when the two-day expedited review would delay care and risk the health or life of the beneficiary, CMS suspended prior authorization requirements for HCPCS codes L0648, L0650, L1832, L1833, and L1851 furnished under following circumstances:

  • Claims for these HCPCS codes that are billed using modifier ST will not undergo prior authorization and will instead be subject to 100% prepayment review.
  • For suppliers furnishing these items under a competitive bidding program exception (as described in 42 CFR 414.404(b)), claims billed with modifiers KV, J5, or J4 would convey that the DMEPOS item is needed immediately and therefore these modifiers will be accepted in addition to the ST modifier. Ten percent of claims submitted using the KV, J5, or J4 modifiers for HCPCS L0648, L0650, L1833, and L1851 will be subject to prepayment review.
Prior authorization helps DMEPOS suppliers ensure that applicable Medicare coverage, payment, and coding rules are met before DMEPOS items are delivered. MBC can help you to receive accurate insurance reimbursements for DME items including prior authorizations, Read Here: https://bit.ly/3Mow0ZZ. To know about our DME billing services, Contact us at info@ medicalbillersandcoders.com/ 888-357-3226
Location: United States

Comments

Post a Comment

Popular posts from this blog

How to Reduce Days in A/R with Smart Denial Management Strategies

-
Image
 Timely reimbursement is the lifeblood of a financially healthy medical practice. Yet, increasing Days in Accounts Receivable (A/R) continues to be one of the most pressing revenue cycle issues for healthcare providers. One of the major culprits behind this issue? Denials. In this blog, we explore how strategic denial management not only reduces days in A/R but also improves cash flow and strengthens your bottom line. Understanding Days in A/R Days in A/R refers to the average number of days it takes for a practice to collect payments due after services have been provided. Industry benchmarks typically suggest keeping A/R days under 35. Anything higher signals inefficiencies - and likely unresolved denials. How Claim Denials Affect A/R Denied claims delay payments and increase administrative burden. Without an effective process to identify, appeal, and correct them, your A/R days will climb - and revenue will suffer. Top causes of denials include: Missing or incorrect ...
Read more

How Outsourced Medical Billing Can Improve Your Practice’s Profitability

-
Image
Managing a medical practice comes with its fair share of challenges—from patient care to staffing and compliance. But one of the most overlooked factors impacting a practice’s financial health is inefficient billing . That’s where outsourced medical billing comes in—not just as a cost-cutting solution, but as a profitability booster . Here’s how outsourcing your medical billing can significantly improve your bottom line. 1. Reduced Administrative Costs Running an in-house billing department requires trained staff, billing software, continual updates, and compliance oversight. These overhead costs can add up quickly. Outsourcing eliminates the need for these expenses, allowing you to pay only for the services you use —often at a fraction of the cost. 2. Faster Claim Submission and Reimbursement Professional billing companies are equipped with experienced teams and advanced tools that ensure quick and accurate claim submission . This minimizes delays and accelerates cash flow , g...
Read more

Understanding the Differences Between Claim Denials and Rejections in Medical Billing

-
Image
In the world of medical billing, two terms often cause confusion for healthcare providers and billing staff alike: claim rejections and claim denials . While both impact revenue and delay reimbursements, they are not the same —and understanding the difference is key to faster, cleaner claim processing. Let’s break it down. What Is a Claim Rejection? A claim rejection occurs when a claim is never accepted into the payer’s adjudication system . It is blocked due to errors or missing information , such as: Incorrect patient demographics Invalid insurance ID numbers Incomplete CPT or ICD-10 codes Formatting errors (especially in EDI files) These claims must be corrected and resubmitted —but the good news is they haven't been officially processed yet, so no appeal is needed . What Is a Claim Denial? A claim denial happens after the payer reviews and processes the claim , then decides not to pay it . Reasons may include: Lack of medical necessity Services n...
Read more