Dermatology Billing Guidelines

Medical billing regulations are constantly changing. As a dermatological practice, it is your responsibility to ensure your medical billing is in accordance with the latest dermatology billing guidelines.

Adapting to the latest dermatology regulations is crucial for accurate reimbursement and compliance. Considering the evolving nature of dermatology billing practices, we thought it would be a good idea to share our expertise and provide you with some tips on staying updated.

Understanding Dermatology Medical Billing Guidelines

Dermatology medical billing is an essential process in revenue cycle management that covers the submission and management of claims regarding the diagnosis and treatment of skin disorders. Medical billing should be done by educated and experienced medical billers to ensure the dermatology practice gets properly and timely reimbursed by the insurance carrier or the patient.

Medical billers must be familiar with dermatology billing guidelines. They must work according to specific guidelines, such as documentation requirements, using the latest coding systems and modifiers, deadlines for claims submission, and follow-up on denied claims. All in all, they ensure an accurate and compliant billing process.

Medical dermatology vs cosmetic dermatology

Dermatology billing can be divided into two categories: medical and cosmetic dermatology. While medical dermatology focuses on helping patients with skin-related issues, cosmetic dermatology focuses on helping patients maintain their youthful appearance.

Since medical dermatology addresses skin issues like acne, skin cancer, eczema, psoriasis, and alopecia, it is typically covered by insurance providers. However, that may not be the case with cosmetic dermatology. As cosmetic dermatology includes treatments such as botox, dermal fillers, laser hair removal, and even skin tightening, these services are typically billed directly to the patient. In most cases, cosmetic dermatology is not categorized as a medical necessity.

Regulatory Landscape

The regulatory landscape governing dermatology billing includes various guidelines. Generally, the dermatology billing process must adhere to HIPAA regulations and contain CPT and ICD-10 codes.

HIPAA

The Health Insurance Portability and Accountability Act contains standards for confidential handling of protected health information in the medical industry. If your dermatology practice performs the medical billing process electronically, you must comply with HIPAA to ensure that sensitive patient health data is secure and is not disclosed to unauthorized entities.

The HIPAA regulations have two rules: Privacy Rule and Security Rule. Privacy mainly focuses on protecting the 18 protected health information, which is further divided into four main categories:

• Demographic identifiers
• Personal number identifiers
• Technology identifiers
• Photo identifiers

In addition, the HIPAA Privacy Rule regulates the provision of patients’ access to their medical records and the maintenance of confidentiality. 

On the other hand, the Security Rule requires your practice to take proper measures to ensure the confidentiality and integrity of the ePHI. The HIPAA regulations also require breach prevention and regular Security Risk Analysis.

Expert tip: You can use the online HIPAA compliance tool during the process of making your dermatology billing compliant.

CPT codes

All dermatology services, treatments, and diagnoses should include an adequate code in the medical claim. Current Procedural Terminology, or CPT in short, is the medical code set of the American Medical Association.

The CPT codes can be either numeric or alphanumeric and include five digits/characters. For easier usage, they are divided into three categories:

• Category I used for procedures and services,
• Category II is used for performance measurement (they are not mandatory for use),
• Category III includes temporary codes for services, procedures, and new or developing technology.

All changes in the CPT codes are published on the CMS and the American Medical Association’s website. The codes are updated once a year and become effective on January 1st of the following year.

E/M codes and ICD-10

A separate part of the CPT is Evaluation/Management codes. They are a short list of codes, ranging from 99202 to 99499, and are used to translate services regarding the evaluation and management of the patient’s health. The ICD-10 codes are widely used. The ICD-10 codes for diseases of the skin and subcutaneous tissue are included in the XII chapter and have blocks from L00 to L99.

Dermatology Coding Best Practices

In the ever-evolving world of medicine, we witness constant advancements in dermatological treatments and technologies. So, relevant coding is required for every change in dermatology practice.

Ensuring accurate data

Many claims are denied because of inaccurate or incomplete data. The dermatology claim must contain error-free data, from the patient’s personal information and reason for visits to insurance details. It is also recommended to check the insurance policy of the patient and see whether it covers the treatments.

Submitting claims promptly

For a healthy revenue cycle of your dermatology practice, you must submit the claims promptly. Every insurance provider and healthcare plan has a specific deadline for submitting claims. As a dermatology service provider, you must be familiar with and adhere to their deadlines.

Monitoring submitted claims and following up on denied claims

After the claim is submitted, your dermatology billing team should regularly check the status of the medical claim and follow up when needed. Some of the best practices include utilizing practice management systems for claim tracking, prioritizing denied claims, timely follow-up, analyzing denial patterns, and improving the coding and billing process.

Hire professional dermatology billing services

Outsourcing makes adhering to dermatology billing guidelines simple. Your organization can remain compliant with the latest regulations and have up-to-date coding and billing processes if you outsource the services to the right company.

Our CLICKVISION BPO experts are here to handle your dermatology billing processes efficiently, timely, and accurately.

Outsourcing your dermatology billing comes with various benefits, such as:

• Access to experienced medical billers who work according to the latest regulations and laws
• Enhanced transparency of the medical coding and billing process
• Seamless medical coding and billing process
• Effective claims tracking and management
• Minimized claim errors
• A lower percentage of denied claims

By outsourcing your medical billing and coding, you can have efficient dermatology billing for a lower price than managing an in-house team.

Documentation Requirements

Every treatment and service billed must be properly documented. Before submitting payment claims, the billing personnel should keep all patients’ records along with the completed medical treatment. The documentation serves as evidence of the medical necessity that the procedures that are to be billed are a medical necessity. Also, accurate documentation helps patients to understand what they are being charged for.

Some of the essential data for a smooth-running reimbursement are:

• Patient personal information and demographics
• Insurance details
• Patient medical history
• Physical examinations
• Diagnostic tests
• Progress notes
• Treatment plans

The lack of documentation will affect your reimbursement. Simply put, if the service provided isn’t documented, it doesn’t get billed.

Compliance Standards

Your healthcare organization must adhere to a wide set of laws and regulations to stay compliant. According to OIG, there are seven core elements of compliance for every healthcare facility, including dermatology providers:

• Implementation of written policies, standards of conduct, and procedures
• Having a designated compliance officer and committee
• Regularly conducting training and education
• Utilizing effective lines of communication
• Carry out internal monitoring and auditing
• Enforcement of standards by utilizing well-publicized disciplinary guidelines
• Prompt responses to offenses

Conclusion

The dermatology billing guidelines are there to ensure accurate reimbursement and compliance. Adherence to guidelines is essential to prevent common errors, reduce denial rates, and avoid legal repercussions, all while maintaining the financial health of your dermatology practice.

If you need help navigating the complex dermatology coding and billing process, we are here to assist you. Contact us today to learn all the benefits of outsourcing with CLICKVISION BPO.