Practice Management

As reimbursement declines and overhead rises, dermatologists can't afford anything short of a perfect billing and collections process. Successful billing outcomes depend on many factors, and entrusting the entire process to someone else without appropriate oversight simply isn't smart business.

The biopsy is a major revenue source for dermatology practices, emphasizing the need for correct biopsy billing practices. Dermatology practices tend to make mistakes in two key areas: basing their billing on intent, and in misrepresenting services.

As an attorney and a consultant to thousands of physicians across the country, we are constantly astounded by the attitudes of physicians regarding the sale of their medical practices. Most often, we hear the complaint that doctors do not feel they can sell their practice for any significant value.

The recession is reminding dermatologists about the importance of excellent service, savvy marketing and a personal touch, experts say. They share lessons for riding out the recession.

Credentialing a new doctor with third-party payers (including Medicare) is a tedious but necessary process. Even small mistakes can result in setbacks - even worse, application denials - all of which can rob dermatology practices of precious revenue, experts say.

Could e-prescribing be a boon to the operation of your practice? Or is it one more layer of bureauracy the federal government is trying to lay on physicians? On Call wondered whether dermatologists are using e-prescriptions, and if so, whether they actually like them.

Recovery audit contractors are the government's hired guns to recover money from Medicare fraud and abuse. Dermatologists need to be ready for these potential audits by becoming familiar with the RAC process.

Just as patients are delaying or downsizing elective treatments, the economy is pushing dermatology practices to do more with less, sources say. From manpower to marketing dollars, practices are economizing while also seeking to maintain - if not improve - patient service.

Although a recent survey indicates many physicians are postponing retirement because of the recession, dermatologists say that - regardless - retirement in their specialty is rare.

Some time ago, I wrote an editorial in this magazine describing my early experience with the use of an electronic medical record. In the article, I indicated that this technology was a valuable addition to the medical office, but there was a fairly steep learning curve and some difficulties in creating a coherent and understandable document. After three years of using an EMR, much of what I said before remains valid.

From fast-food restaurants churning out a meal in just minutes to the Internet culling through millions of documents in mere seconds, Americans are used to getting what they want, and getting it now. Have you figured the value of patient access to your practice?

Casselberry, Fla. - Incorrect use of modifier 59 in dermatology is the single most common reason for claim denials by Medicare and commercial insurance carriers, according to Inga C. Ellzey, M.P.A., R.H.I.A., C.D.C., president and chief executive officer of Inga Ellzey Practice Group, Casselberry, Fla.

Physicians are looking for ways to control costs and increase income as malpractice premiums and practice overhead costs skyrocket and rates paid by insurers decline. Many physicians have exhausted cost-control measures, and most are not aware that they can increase their revenue by improving coding and overall claim processing and reviewing their payer contracts.

The slide preparation lab seems a logical extension of dermatology practice, yet few dermatologists tap into this revenue-producing option. Adding a histopathology component to your practice generates long-term revenue to help make up for dwindling reimbursement and aesthetic devices.

Dermatologists say they will vigorously oppose many portions of the newly passed healthcare reform bill, although they say it's too soon to determine exactly how. Chief objections are the bill's creation of an independent payment advisory board (IPAB) for Medicare and lack of a fix for Medicare's sustainable growth rate (SGR), sources say.

Internet-based patient portals are Web sites with real horsepower. In addition to posting static information, such as office hours, physician and staff profiles and a list of services, portals deliver functionality to patients. These points of virtual access to your practice generate patient satisfaction because they provide convenient, 24-hour, self-service options to handle many interactions with your practice.

On Call talked to dermatologists across the country and asked them to explain when they believe Mohs surgery is appropriate, whether they consider the surgery overused, and whether they've run into issues with reimbursement.

The new decade started out to be challenging, frustrating and concerning for everyone. Whatever the future brings, it is evident that physicians who want to remain profitable and avoid decreases in their practice revenues must be proactive.

There's nothing more frustrating to patients and staff than a dermatologist who constantly runs behind. Running behind is a vicious cycle; until you root out its causes and take action, everyone - including you - will be miserable.

The business climate of medicine has led more dermatologists to join group practices. That means doctors of widely varying ages often work side-by-side. What impact does that have on the practice of medicine?

Love or loathe them, public Web sites that let patients rate their physicians aren't going away, experts say. Making these sites work for you rather than against you requires ongoing vigilance, broad-based patient participation and - for some physicians - patient contracts, they add.

We asked a number of doctors around the country whether they are adding procedures, therapies or equipment to their practices this year, and how those plans are being impacted by economic conditions. While some dermatologists are being cautious, others are actually using the economic challenges to plan for the future of their businesses.

A recent study that ranks dermatology among the most satisfying medical specialties to practice finds agreement among dermatologists, who count the specialty's diversity, flexibility and visual nature among its charms.

Dermatologists are one step closer to understanding how to access the electronic health record (EHR) incentive payments promised in the federal American Recovery and Reinvestment Act (ARRA). Enacted in February 2009, ARRA provides incentives for physicians who demonstrate "meaningful" use of a certified EHR system.

We are receiving a lot of calls and e-mails regarding which Medicare fee schedule dermatology practices are supposed to use starting Jan. 1. There is a lot of incorrect information floating around from various sources.

Recently, a 27-year-old woman consulted me about hair loss of several years' duration. She was in otherwise good health, and she proved this by showing me an impressive list of perfectly normal laboratory results indicating, among other things, that she did not have anemia or thyroid disease.

A recent study that ranks dermatology among the most satisfying medical specialties to practice finds agreement among dermatologists, who count the specialty's diversity, flexibility and visual nature among its charms.

With all of the talk about the government's EMR stimulus package, new CPT codes, and the impact of the turbulent economy, you wouldn't pick dress codes as a big concern for medical practices. But as the newest generation entering the work force starts filling positions at your dermatology practice, it won't be long before you, too, may need to establish - or update - your practice's dress code.

Politics is a popular but touchy subject. We wondered whether dermatologists' patients are raising the issue of healthcare reform during visits, and, if so, how the derms are handling those questions.

As a physician, do you realize that, between income, capital gains, Medicare, self-employment and other taxes, you spend 40 percent to 50 percent of your working hours laboring for the IRS and your state?