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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Skilled Nursing Facility 3- Day Rule Waiver

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CMS is waiving the requirement at Section 1812(f) of the Social Security Act for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF 3- Day Rule Waiver) stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who need to be transferred as a result of the effect of a disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period. Second, CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission.

Background

Under the Shared Savings Program, the Centers for Medicare & Medicaid Services (CMS) enters into a participation agreement with each participating Accountable Care Organization (ACO). CMS will reward eligible ACOs when they lower growth in Medicare Parts A and B fee-for-service (FFS) costs (relative to their ACO-specific benchmark) if, at the same time, they meet performance standards on quality of care.

The SNF 3-Day Rule Waiver waives the requirement for a 3-day inpatient hospital stay prior to a Medicare-covered, post-hospital, extended-care service for eligible beneficiaries. Only Shared Savings Program ACOs that are currently participating in, or applying to, certain Shared Savings Program performance-based risk tracks have the opportunity to apply for a waiver of the SNF 3-Day Rule, and they must apply separately for the waiver during the annual application process.

Read more regarding Skilled Nursing Facility 3- Day Rule Waiver: https://bit.ly/3e5qNev. also you can get in touch with us at info@medicalbillersandcoders.com or call us at 888-357-3226.

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