Dermatology billing and accounts receivable

Lesion destruction, excision sizing and Mohs staging make dermatology heavily documented and heavily audited.

Where the money leaks in dermatology

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Excision size documented after closure rather than before
• Benign versus malignant destruction coded from an unconfirmed pathology
• Mohs stages billed beyond payer limits
• Modifier 59 on multiple lesion removals rejected as unbundling
• Cosmetic versus medically necessary determination not documented

What a seat does about it

One trained person works your queue from the difficult end. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing.

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and certified coding at $2,500.

The codes those turn into

Each of these is a denial code you are likely to meet working dermatology, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-16 — Claim lacks information
  Something on the claim is missing or malformed. On its own the code tells you nothing — the detail is in the remark code that comes with it.
  Recovered by being corrected and resubmitted. Matched from: “Modifier 59 on multiple lesion removals rejected as unbundling”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and about about 90% of initially denied claims are eventually paid. Most of what sits in a dermatology AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

Questions