What’s Really Happening With Prior Authorizations in Dermatology?

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Prior authorizations in dermatology are becoming more complex, more restrictive, and more time-consuming, leading to increased claim delays and revenue disruption. As biologics, specialty drugs, and advanced dermatologic procedures become more common, payers are tightening approval requirements. This shift is directly affecting dermatology billing , reimbursement timelines, and administrative workload. Understanding the current landscape is critical for protecting practice revenue. Why Are Prior Authorizations Increasing in Dermatology? The rise in prior authorizations in dermatology is largely driven by high-cost biologics and specialty treatments. Key factors include: Expensive biologic therapies Step therapy requirements Formulary restrictions Increased payer cost control strategies Because dermatology treatments often involve long-term therapy, payers apply strict review standards before approving coverage. How Are Prior Authorizations Impacting Dermatology ...
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Common Outpatient Rehabilitation Therapy CERT Errors

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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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