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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Common Outpatient Rehabilitation Therapy CERT Errors

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commonoutpatientrehabilitationtherapycerterrors.jpg

Billing Part B Outpatient Therapy Services

Outpatient rehabilitation therapy includes Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) services. Medicare covers outpatient PT, OT, and SLP services when:

  • A physician or Non-Physician Practitioner (NPP) certifies the “treatment plan,” called the Plan of Care (POC), ensuring:
    • A patient needs therapy services 
    • POC is: 
      • Established by a physician, NPP, our qualified therapist provides services 
      • Reviewed periodically by a physician or NPP 
    • A patient gets services under physician care 
  • POC certifying the provider’s name and NPI is on the claim 
  • Providers meet medical necessity, documentation, and coding requirements

where, 

  • CERT: Comprehensive Error Rate Testing
  • A physician is a Doctor of Medicine, osteopathy, podiatric medicine, and optometry (only for low vision rehabilitation). 
  • NPP includes a Physician Assistant (PA), Clinical Nurse Specialist (CNS), or Nurse Practitioner (NP). 
  • A qualified Therapist includes a PT, OT, or SLP who meets regulatory qualifications as applicable, including state licensure or certification.

Common Outpatient Rehabilitation Therapy CERT Errors

  • Missing certification and recertification(s): Physician’s, NPP’s, or therapist’s dated signature(s) approving the POC. Prevention: Confirm physician or NPP certified the POC (and recertified it when appropriate) with their signature and date.
  • Missing signature: Physician, NPP, or therapist who developed the POC and established treatment plan date. Prevention: Ensure you add your dated signature and professional identification (for example, PT, OT).

To learn more about Common Outpatient Rehabilitation Therapy CERT Errors, click here: https://bit.ly/3qSdiEY Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

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