Practice Management

Starting a successful cosmetic dermatology practice requires a systematic approach to everything from networking and staffing to advertising and office decor.

Analyses based on census data and membership surveys from the American Academy of Dermatology, the American Osteopathic Association, and professional societies for physician assistants and nurse practitioners show inroads are being made to improve workforce

The physician removed a cyst from the patient's right upper back. The cyst measured 5.0 centimeters in diameter, but it was removed through a 0.9 x 3.1 cm/d opening. I billed the excision based on the 5.0 centimeter size. Is that correct? - Looking for an Opening

To offset the trend of falling reimbursement, you can either see more patients or cut costs. Before you try doubling your patient load or handing out pink slips to your entire staff, consider these ideas to trim expenses in your dermatology practice:

A couple of years ago I changed my e-mail address from AOL to Gmail. I am still redirecting people from my AOL address to Gmail, and I am still finding document templates, organizations and directories that have not updated my e-mail address.

Motivating employees and fostering a happy, healthy work environment requires a little extra effort. Let employees know your expectations and let them know they are appreciated for a job well done.

National report -- For dermatologists interested in posting online videos, experts offer these do's and don'ts.

National report - Now that picture-and-text websites are commonplace, dermatology practices that want to stand out are finding that online videos fit the bill, sources say. This may be particularly true for cosmetic-oriented practices, they add.

Simple steps can transform the office visit from one that is forgettable for the dermatologist, patient and staff to one that is unforgettably positive.

From a financial perspective, your time should be spend in billable activities.

A panel of experts offers short tips for making things run smoothly, creating a positive work environmen and generating more revenue. Empowering staff improves efficiency and boosts morale.

A recent survey of physician assistants suggests these staff members must spend on average eight months in dermatology offices prior to seeing patients independently to feel comfortable in this role

When the features of the SIMPLE IRA plan and the traditional 401(k) plan are combined into one plan, there are considerable advantages for both employees and business owners.

The elimination of the Mohs surgery exemption to Medicare's multiple-surgery reduction rule will mean that Mohs surgeons who perform multiple in-office surgeries in one day will earn less for secondary procedures than they cost, sources say.

Medicare coverage does not resume until a patient's total yearly out-of-pocket spending is well over $3,000.

At most dermatology and cosmetic practices, between 2 percent and 10 percent of accounts receivables (A/R) are actually credits.

With the introduction of new Mohs codes and changes in the definitions of the destruction codes for premalignant and benign lesions, lots of questions and concerns are being generated from not only physicians but their billing staffs as well.

National report - While dermatology's visual nature makes it ideal for image-rich electronic applications - from teledermatology to training for residents - few dermatologists have embraced comprehensive systems such as electronic medical records (EMRs), sources say. But they predict this will change with the healthcare industry's growing emphasis on efficiency and accountability.

Although the CPT coding changes affecting dermatology for 2007 were not numerous, they were some of the most significant ever.

But when it comes to 17000 and Mohs codes, used almost exclusively by dermatologists, Dr. Pariser says, "We have no one with whom to form alliances. We're stuck out on our own."

Q A patient had a biopsy and the pathology report showed the lesion to be a basal cell carcinoma. We schedule the patient back for an excision. We sent the excision tissue out again. The final pathology came back showing no residual cancer cells; only scar tissue.

The insurance companies with whom you do business appreciate your services but they are ultimately responsible for ensuring that their business - not yours - stays healthy.

Washington - Doctors will see a 5 percent cut in Medicare reimbursement rates next year. But the government will pay physicians more to counsel patients on ways to improve their health, according to the Associated Press.

Survey results recently released by the American College of Physician Executives paint a grim picture of physician morale across the United States. The survey indicates that nearly 60 percent of physicians have considered leaving the practice of medicine for varied reasons including: declining reimbursement, increasing patient loads, lack of respect and loss of autonomy.

Imaging services represented some 14 percent of 2005 spending that is considered in the formula used to calculate Medicare rates, and 27 percent of the total spending increase between 2004 and 2005.

I do a lot of complicated skin cancer repairs and I have never really been very sure of the correct way to code for this particular type of closure: the purse string repair. I have spoken with several of my colleagues and everyone seems to be coding this differently. I have also scoured the CPT book with no real hints at what I should code. What do you think?

A hospital may provide your practice a qualifying EHR or e-prescribing system and forego - or donate - up to 85 percent of the system's cost.

Q A new patient who just moved into town was seen for a dark mole on the chin. After taking the appropriate history and doing an exam, the dermatologist decided to perform a diagnostic biopsy. The patient also indicated she had been treated for acne in the past and asked for a prescription refill. Would the diagnosis for the new patient E/M visit be the neoplasm of undetermined nature (e.g. 238.2) or should I attach the acne diagnosis? I remember reading that the primary diagnosis is the reason the patient came into the office and that should be used as the diagnosis for the office visit. However, many times carriers don't pay if there is only one diagnosis for both the procedure and the E/M visit. Would I be committing fraud if I used the acne diagnosis for the office visit?

Toronto - The most important way to avoid having dissatisfied cosmetic patients is to emphasize good patient selection, an expert says.

In a study comparing traditional cannula use on one thigh and the power cannula on the other, Dr. Katz found that bruising, swelling and pain were significantly reduced on the side on which the power cannula was used.