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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Know your DME HCPCS Codes

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In DME medical billing, your DME coders require correct HCPCS codes and correct modifiers for providing more details about the equipment. If your medical coders cannot use modifiers or not correctly use them, then the insurance company may deny the claims. Some common DME modifiers include RR- rental, UE- purchase of used equipment, and NU- purchase of new equipment. Know your DME HCPCS Codes

When a laboratory demand, request for DME is being filled, medical coders will be needed for ICD-10 codes for a patient’s diagnosis.

To use an appropriate HCPCS code for the DME item, many HCPCS codes need a modifier. Modifiers are used to provide more details about the DME item. e.g. The modifier might indicate to HMSA that an item is new, rented on a capped basis, or rented. For capped rentals, modifiers differentiate which month’s rental is being billed.

If your billers misuse these modifiers then the claim will be rejected. To speed up this process of your claims, show the first-month rental by adding the appropriate modifier code and bill your claims in successive order.

Outsource DME Billing Services to MedicalBillersandCoders – The Leader in Medical Billing & Coding

HCPCS Code Range:

E0100-E8002: Durable Medical Equipment

E0100-E0159: Walking Aids and Attachments

E0160-E0162: Sitz Bath/Equipment

E0163-E0175: Commode Chair and Supplies

E0181-E0199: Pressure Mattresses, Pads, and Other Supplies

E0200-E0239: Heat, Cold, and Light Therapies

E0240-E0249: Bathing Supplies

E0250-E0373: Hospital Beds and Associated Supplies

E0424-E0487: Oxygen Delivery Systems and Related Supplies

E0500-E0500: Intermittent Positive Pressure Breathing Devices

To learn more about Know your DME HCPCS Codes, click here: https://bit.ly/3rLoDUp Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

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