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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Medical Coding and Billing Changes for Family Practice in 2015

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The CPT 2015 will have approximately 550 new, revised, or deleted codes. It will also include revised guidelines and terminologies. These changes will affect family medicine physicians, cardiologists, radiologists, and internal medicine practitioners too. Similar to other medical specialties, family medicine will have to gear up for dozens of new and revised vaccine codes in 2015. It will include additions of 90630 and 90654 codes for flu immunizations. Our Family Practice billing services team can provide you with high-quality and error-free patient demographic and Family Practice charge entry services.

The 2015 coding changes will alter the way family medicine practices report vaccinations, chronic care management services, and arthrocentesis (joint aspiration). Some descriptor changes to old codes will also affect this medical specialty.

Coding Changes for Family Practice Medicine Practitioners

Family medicine providers need to take CPT coding changes into serious consideration if they want to make the most of their reimbursement opportunities. Here are some of the CPT 2015 code revisions, deletions, and additions that will affect family medicine practitioners in the next year.

Two new vaccine codes will be added in 2015, just like it was done in 2014. These two new codes and descriptor changes for vaccination will include:

  • 90630 – Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
  • 90651 – Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58 nonavalent (HPV), 3 dose schedule, for intramuscular use

The addition of these two codes has been announced by the CMS; however, the FDA is yet to approve them. The codes 90654, 90734, 90721, and 90723 will go through descriptor changes. These codes had been primarily revised for distinguishing the existing codes from new ones that are to appear in 2015.

Apart from these coding changes, new CPT codes will be added for arthrocentesis. The new codes for the joint aspiration are 20604, 20611, and 20606. These codes need to be reported by the family physicians when they perform procedures that involve ultrasound guidance.

For instance, 20600 will have to be used when a procedure is performed without ultrasound guidance and 20604 needs to be used when ultrasound guidance is used with permanent reporting and recording. Some ‘arthrocentesis’ codes will also go through description changes such as 20600, 20610, and 20605.

These are some of the scheduled CPT code changes for 2015. If family medicine physicians fail to update their coding with the above-mentioned requirements, they will have to face claims denials effective from January 01, 2015.

To learn more about Medical Coding and Billing Changes for Family Practice in 2015, click here: https://bit.ly/3qmOGDV Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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