Florida Dermatology Billing: The Vendor Evaluation Questions That Reveal CO-50 Defense and Mohs Billing Capability

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Choosing a medical billing or RCM vendor for a Florida dermatology practice requires more than comparing collection percentages and monthly fees. Dermatology billing has specialty-specific risks, particularly when a practice performs Mohs micrographic surgery, pathology-related services, biopsies, and other procedures where documentation, medical necessity, coding, and payer policies directly affect reimbursement. One important area to examine is the vendor's ability to prevent and defend CO-50 denials . CARC 50 indicates that a service was considered non-covered because the payer did not determine it to be medically necessary. CMS guidance also shows that CO-50 can be used following medical review when a payer determines that coverage requirements have not been met. For a Florida dermatology practice, the vendor evaluation process should therefore go beyond asking, "How much do you collect?" The better question is: "How do you protect our revenue when a payer challe...
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MACRA/MIPS Reporting in 2017: What’s in Store for 2018?

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As physicians, doctors, healthcare units, ASCs, and medical billing and coding companies observe this year’s passage of the newly laid MACRA/MIPS reporting rule, there are a lot of dilemmas about its positives and avoidance for the year 2018. However, it will be important to notice whether the final rule continues to trend toward value-based care. Also, given the intricacy and sweeping nature of QPP, it is yet to be seen whether or not positives and avoidances will alleviate administrative burden.

Understanding the MACRA/MIPS Proposed Rule

Experts, including those working in the government, who are keenly observing the scenario, have some important takeaways from the proposed rule:

  1. Around 34%-36% of physicians will be eligible for MIPS after all exclusions, although they make up 55%-58% of Medicare Part B charges.

MACRA/QPP is an enormous piece of legislation. At its business end, it will eliminate the sustainable growth rate formula and replace it with a 0.5% annual rate increase throughout 2019, after which physicians will be or will be encouraged to shift to one of the two Quality Payment Programs:

  • Merit-Based Incentive Payment System (MIPS)
  •  Alternative Payment Model (APM).
  1. The proposed scenario for the 2018 rule includes the option for providers to band together in Virtual Groups.

If you remember, this option was not available in 2017. The situation with Virtual Groups is that they allow solo practitioners or physicians in groups of 10 or fewer to combine for MIPS participation virtually. To become a Virtual Group, a solo practitioner or group must combine with at least one more solo practitioner or group, regardless of location or specialty. Make sure you register before the 2018 performance year also solo physicians must be eligible for MIPS on their own.

  1. Hospital-based doctors can now report at a facility level as well

Hospital-based physicians in the year 2018 MIPS performance period will now have the opportunity to be evaluated on quality and cost, in the context of the facilities where they practice. Such physicians can submit their facility’s in-patient value-based score to help calculate an individual score.

Experts think that such a move could be a big win for administrative simplification, as before, there was no recognition or special category for doctors who work in facilities such as a hospital.

To learn more about MACRA/MIPS Reporting in 2017: What’s in Store for 2018?, click here: https://bit.ly/46J84vg, Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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