Practice Management

From cash payments to fee-for-service insurance to gatekeepers to HMOs, PPOs and IPAs; from high deductibles to wellness exam reimbursement - the saga of insurance coverage is ever-changing.

Dermatologists and other physicians can expect increased pressure to provide prescriptions electronically as one method of reducing medication errors, which the Institute of Medicine (IOM) of the National Academies says harm at least 1.5 million people every year.

Evaluation and management (E/M) services continue to be one of the most complicated issues in dermatologic billing. Whether it's how to document properly based on the level of care provided or getting paid for the various types of E/M services when procedures are billed on the same date of service, it all seems to be an uphill climb.

The debates over what to do with medical malpractice are complex and now longstanding.

American Academy of Dermatology President Stephen Stone, M.D., outlines an ambitious and ongoing agenda for the AAD that includes efforts to correct problems with the national iPLEDGE registry, to improve Medicare reimbursement and reform medical liability, and to protect the scope of practice of the specialty.

On an ongoing basis, our office receives denials from managed care plans stating that repair codes are bundled or "incidental to" the excision codes.

Dermatologists and other physicians who establish interoperable electronic health records systems in their practices can expect to be rewarded with increased compensation under the pay for performance policies being established at the Centers for Medicare and Medicaid Services (CMS).

There is grave concern in the academic community about the limited number of young physicians, including dermatologists, who are opting for careers in private practice instead of choosing a career in academics. The obvious question that arises is, will there be enough professors of dermatology in years to come to train the next generation? If there aren't a sufficient number of dermatology faculty members to train new dermatologists, who will be capable of providing high-quality care to patients with serious skin disease?

CPT codes 17000, 17003 and 17004 are the bread-and-butter codes ofmost dermatologists. Actinic keratoses, warts and other benignlesions such as seborrheic keratoses, condylomata and papillomataare the most common types of lesions treated by the destructionmethod. Per CPT, the definition of destruction means "the ablationof benign, premalignant or malignant tissues by any method, with orwithout curettement, including local anesthesia, and not usuallyrequiring closure.

Common legal issues facing physicians who perform cosmetic laser treatments include medical malpractice, as well as issues related to physician extenders and the Health Insurance Portability and Accountability Act (HIPAA), an expert says.

Are you thinking about hiring a physician extender? Or did you justhire one? If so, be sure you know how to bill payers for theservices that these nonphysicians provide in your dermatologypractice.

Two major changes regarding the billing of E/M visits affectedDermatologists significantly over the past six months.Specifically, the issues involved the bundling of E/M visits inMedicare's Correct Coding Initiative and the new consultationguidelines that went into effect on January 1, 2006. In thisarticle I'll try to unravel some of the confusion and hopefullysteer everyone in the right direction.

Is this the year for medical liability reform in Washington? Or isthe best option for those seeking relief to focus their efforts onthe state lawmakers in those states where help is needed most?

Why is a good handbook so important? By setting clear ground rules for employees, the handbook can also protect you from lawsuits if someone claims to have been unfairly disciplined or fired.

There are so many changes that affect coding and reimbursement, it's not difficult to understand that some of the changes are not well-received by dermatologists. This is especially true with many new services that include costly drugs and equipment and that require a significant amount of physician time to perform.In this issue, I'll share some questions sent in by frustrated readers, their solutions to the reimbursement dilemmas, and my "You can't do that" advice.

Dr. EMR, a technologically oriented dermatologist, has been using electronic medical records for two years.

National report ? As in any profession, the practice of dermatology is subject to the vagaries of trends that can affect every practitioner.

The new guidelines that regulate physicians who prescribe isotretinoin for their patients are demanding and time-consuming.

Four key areas to look at when evaluating a billing service are: integration, performance, cost and relationship.

One of the biggest changes in the 2006 CPT book involves the grafting section of the Integumentary System. There were many deletions, a host of new codes and a significant number of amendments to the rules and guidelines that govern these complex surgical procedures.

Presently, VistA-Office EHR supports electronic reproductions of paper patient charts, from vital sign entry and viewing to problem list and medication management.

Pressure is building in Washington to move forward with the federal government's proposed pay-for-performance Medicare reimbursement program.

National report — Experts tell Dermatology Times that in addition to learning to do more with less, dermatologists face financial challenges unique to their specialty.

Year 2005 was filled with many changes that affected dermatologists and how they billed Medicare and other commercial carriers. Year 2006 is anticipated to be an equally challenging year. In this article, I will highlight what I feel was important this year and what you need to be aware of in the year ahead. Due to the space constraints of this article, I cannot go into great detail, but I will at least let you know what you should be aware of and what you need to implement.

The dashboard won't tell you why something is going wrong, but by identifying variances it will give early warning to potential problems.

Q I billed Medicare for the following services. All of the Mohs procedures were denied. Patient was in a 90-day postoperative period for a flap that was done 20 days earlier. Tell me how I should have coded to avoid the denials of my Mohs services?

San Francisco — Switching to electronic health records (EHRs) could prove costly and time-consuming for some small medical practices, according to a recent report.

Teach your staff the mantra: If you can predict it, you can manage it.

Typically, you will be completely dependent on your high-speed Internet connection, and may not be able to function without that connection.

If you inquire regarding (a carrier's) policy regarding PAs supervising staff, always get the advice in writing.