Dermatology Payments Likely to Reduce in 2015 and Further

by | Published on Feb 16, 2015 | Insurance Verification and Authorizations

Dermatology Payments
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It’s time to focus on your dermatology medical billing as new developments in the healthcare field implies a reduction in physician payment in 2015 and may be in the coming years. In October 2014, the Centers for Medicare and Medicaid Services (CMS) published the Medicare Physician Fee Schedule Final Rule that describes changes to physician reimbursement for 2015. As per the finalized policies in the fee schedule, there will be an overall 2 percent reimbursement cut for dermatology services this year.

Dermatologists who did not meet the federal EHR meaningful use standards by October 2014 are going to face Medicare payment cuts of 1% in 2015 and 2% in 2016. CMS has already announced that more than 50% of eligible professionals will face penalties under the meaningful use program in 2015. However, it is not easy to maintain your payment with meaningful use, if already participated into the EHR incentive program. The Office of Inspector General (OIG) is considering a review of EHR adoption and meaningful use in its work plan for fiscal year 2015. The documentation for meaningful use should be kept accurate and secure to avoid penalties.

One of the most common ways in which a physician can be audited is finding a mismatch of denominators for multiple measures. Multiple measures do have a denominator of unique patients and if that denominator is not the same for each measure that requires it, the provider will be at a high risk for audit. Practices must save any information that supports their meaningful use attestation through screenshots as well as data reflecting clinical quality measures. In this way, they can address audits more effectively.

Changes to Global Periods

As per the American Academy of Dermatology, there will be a reduction to dermatology payment resulting from changes to global periods. Owing to the concerns regarding the accuracy of the valuation of global payments, CMS will eliminate global periods and value all surgical codes according to the surgical day of service and then pay separately for the follow-up services provided. This may require additional co-pays for follow-up visits. Global packages comprise the procedure and the services typically rendered in the periods immediately before and after the procedure. From 2017, CMS plans to implement this change for surgical codes having a 10-day global service period while they plan to implement the same change for surgical codes having a 90-day global service period. However, CMS does not provide a clear methodology of how to revalue codes as 0 day global codes.

These changes could result in reimbursement reduction due to the loss of the automatic payments included in the global period. Many dermatologists do not submit a claim nor are they required to submit it while seeing their patients for follow-up visits during the global period. Dermatologists will be allowed to bill and get reimbursed for the surgical day of service when CMS unbundles the follow up visit and each E/M visit required for appropriate follow-up.

As the number of insured patients is increasing as a result of the Affordable Care Act (ACA), dermatologists will see a huge influx of patients. In order to take advantage of this situation better, consider obtaining services from a medical billing and coding company that offers the service of experienced billing specialists. They can take care of the entire revenue cycle from patient scheduling to claim submission and denial management, and conduct internal audits to confirm that clean claims are submitted to insurers with accurate documentation supporting them.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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