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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Expanding Medicare Telehealth Use after PHE

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CY 2023 Medicare Physician Fee Schedule Proposed Rule

On 7th July 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. This calendar year (CY) 2023 PFS proposed a rule that made lots of provisions including expanding Medicare telehealth use even after the end of a public health emergency (PHE).

Expanding Medicare Telehealth Use after PHE

For the calendar year 2023, CMS is proposing a number of policies related to Medicare telehealth services including making several services that are temporarily available as telehealth services for the PHE available through CY 2023 on a Category III basis, which will allow more time for collection of data that could support their eventual inclusion as permanent additions to the Medicare telehealth services list. CMS is proposing to extend the duration of time that services are temporarily included on the telehealth services list during the PHE, but are not included on a Category I, II, or III bases for a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022).

CMS is proposing to implement the telehealth provisions in the CAA, 2022 via program instruction or other sub-regulatory guidance to ensure a smooth transition after the end of the PHE. These policies extend certain flexibilities in place during the PHE for 151 days after the PHE ends, such as 

  • allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, 
  • allowing certain services to be furnished via audio-only telecommunications systems, and 
  • allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services. 

To learn more about Expanding Medicare Telehealth Use after PHE, click here: https://bit.ly/46fYgsF Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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