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Showing posts from November, 2023

Why Are Dermatology Biologic Claims Facing Increased Denials in 2026?

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Dermatology biologic claims are facing increased denials in 2026 due to stricter payer policies, prior authorization requirements, documentation scrutiny, and evolving reimbursement guidelines. Biologic therapies are high-cost treatments commonly used for psoriasis, eczema, and other chronic dermatologic conditions. Because of their expense and long-term use, payers are applying tighter review processes, leading to more frequent claim denials and payment delays . Understanding these trends is essential for protecting revenue in dermatology practices. What Is Driving Higher Denials for Dermatology Biologic Claims? Several factors are contributing to rising dermatology biologic claim denials in 2026. Key drivers include: Stricter prior authorization policies Step therapy enforcement Limited formulary coverage Increased medical necessity documentation requirements Frequent policy updates by commercial payers Failure to meet any of these requirements often results...
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Physician Credentialing: Worth Getting Right to Get Paid

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  Physician Credentialing Physician credentialing is the process of organizing and verifying the professional records that qualify a doctor to practice medicine. As physicians, despite your reputation for benchmarked medical services, you could be losing out when it comes to realizing medical bills reimbursed fully by respective health insurance carriers. And when you start to analyze that elusive reason responsible for hampering your reimbursements, you invariably end up discovering ‘Credentialing’ as the chief culprit. Quite a contrast to the earlier scenario, wherein your credential as a qualified and competent practitioner could alone determine your practice’s sustenance and growth, the present-day scenario, characterized by innumerous practitioners and a heterogeneous mix of insurance carriers, requires your practices to bear the stamp of ‘Credentialing’ to stay well clear of audit, delay or denial exposures. Although physician practices are required to be credentialed by ...
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Location: United States
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2022 Revised Codes for Principal Care Management

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  In the Final Medicare Physician Fee Schedule (MPFS) for 2022 issued on November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) added five new CPT codes in the categories of Chronic Care Management (CCM) and Principal Care Management (PCM) and increased reimbursement for already existing codes in the same categories. These codes are like chronic care management services in that the work involves the establishment, implementation, revision, and monitoring of a care plan for a patient. However, principal care management focuses on a single condition (rather than two or more). In the year 2022, Medicare will accept CPT codes 99424, 99425, 99426, and 99427, and discontinue HCPCS codes G2064 and G2065. 2022 Revised Codes for Principal Care Management CPT 99424: Principal care management services, for a single high-risk disease, with the following, required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at...
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Location: United States
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Why does your Staff Fail to Collect Revenue from Patients?

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  After 25 years of training medical practice staff how to successfully ask patients to pay at the point of service, there are many common excuses that we hear when staff members fail to collect Revenue from Patients. As per the Consumer Financial Protection Bureau (CFPB) report released in December 2014, 43 million citizens have overdue medical debt and a staggering 52 % of all debt on credit reports is from  medical billing . The findings of the study clearly indicate that patient collection is becoming a  serious threat to the profitability of the provider’s office. Factors like ongoing economic instability combined with the implementation of the Affordable Health Care Act and the shift in payment models to be consumer-direct with high deductibles have all consolidated into greater difficulties for the provider’s office at revenue collection from patients. Reasons Your Staff Fails to Collect Revenue from Patients To elaborate, here are a few reasons why provider’s ...
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Location: United States
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Understanding 8-Minute Rule for Therapists

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  Introduction The therapy 8-minute rule is a vital concept for therapists, specifically in the context of billing Medicare or Medicaid for their services. This rule allows therapists to calculate the appropriate number of billable units based on the duration of direct contact therapeutic services provided to a patient. Understanding the 8-minute rule is essential to avoid billing errors, delays in reimbursement, audits, and underbilling. In this article, we will delve into the intricacies of the therapy 8-minute rule, its application in therapy billing, and how to calculate billable units accurately. What is the Therapy 8-Minute Rule? The therapy 8-minute rule refers to the method used by therapists, including occupational therapists, physical therapists, and speech therapists, to determine the number of billable units for Medicare or Medicaid reimbursement. It applies to timed services where therapists provide one-on-one sessions with patients for at least eight minutes. Sin...
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Location: United States
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