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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HIPAA Rules: Penalties and Criminal Liabilities

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HIPAA was officially enacted in the year 1996 by the United States Congress. HIPAA has two titles–Title I of the rule is to protect individuals and families when they lose their jobs or change their jobs. Title II also known as the administrative simplification provision requires the establishment of electronic healthcare transactions to protect the identity of providers, health insurance plans, and employers. All Covered Entities and Business Associates must follow all HIPAA rules and regulations.

Title I has been a debated topic with health coverage of many individuals going under constant change looking at the job security of American individuals. I am covering individuals under health care policy after significant breaks.

Title II is known as the background regulation of the healthcare industry as the industry moves toward the technologically vibrant sector.  With Information becoming the new currency, the law was made to protect the patient’s healthcare information.

According to the law here are some insights about the HIPAA Regulations

U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) takes up the initiative of implementing the HIPAA security and privacy laws. OCR checks the following during the investigation process

  1. Investigating complaints filed with it.
  2. Conduct a compliance audit to determine whether the covered entities comply.
  3. Educating and reaching out to foster compliance.

In the case of non-compliance where the doctor’s office is not resolving the matter satisfactorily, OCR may decide to impose monetary penalties.

To learn more about HIPAA Rules: Penalties and Criminal Liabilities, click here: https://bit.ly/3ZMvHQI, Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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