Practice Management

Although everyone in the medical billing environment tries hard to follow all the rules set forth by the many managed care plans, the American Medical Association, Children's Medical Services, the Office of the Inspector General, as well as State and Federal statutes, mistakes do occur.

Washington - As the federal government considers a regulation to implement the 2005 Medicare physician fee schedule under the new Medicare Modernization Act (MMA), many specialty groups - including dermatology - are concerned that physician fees will suffer unless some specific problems are fixed.

Many reliable sources will be providing physicians and staff input regarding all the changes set forth by the American Medical Association (AMA) and the Center for Medicare & Medicaid Services (CMS) for fiscal year 2005. Based on the display copy of the Nov. 2, 2004 Federal Register, the 2005 AMA CPT book, and the ICD-9-CM Book for 2005 published by the World Health Organization, pertinent changes for dermatology practices are summarized below:

For the past few months, I have been a part of an arbitration panel of physicians, hired by an organization that gives independent opinions concerning claims for reimbursement for medical providers, pre-authorization issues and quality of care issues.

Incision and drainage services are commonly performed dermatologic services; although, they are frequently billed incorrectly causing unnecessary denials and reviews.

Cross training is good for the physician, because it provides more flexibility in managing the efficiency of the practice when employees are absent.

New York - When Joseph S. Eastern, M.D., started practicing in the early '80s, if physicians' practice income didn't cover their office expenses, they raised their fees. Changes came about in the 1990s with the proliferation of managed care. Insurance companies started dropping fee-for-service insurance plans in favor of reimbursement caps, or negotiated lower fees - often based on reduced reimbursements authorized by Medicare.

Dermatologists want to hear more specific plans for healthcare from both candidates.

Security is the most critical component. Does the e-mail package you're considering meet the 2005 HIPAA guidelines for patient privacy and security? And does the hosting company have the ability to safely share files between two or three offices?

Boston - Improvements on a non-invasive alternative to liposuction may revolutionize medical procedures in this area, according to a presentation at this year's International Master Course on Aging Skin.

With so much emphasis over the past year on HIPAA and concerns about the downward spiraling reimbursement rates from Medicare and commercial insurance carriers, very little attention has been focused on internal auditing and compliance efforts.

New York - Doctors should periodically review the parameters of all the insurance plans to which they belong to see if any are not keeping step with the others.

Although most everyone in billing is generally very comfortable with ICD-9-CM diagnosis coding, it's still not uncommon for me to receive faxes that demonstrate that there is still some bad coding going on in dermatology practices.

Dr. Ron has finally learned to deal with all the new privacy requirements of HIPAA. He provides reasonable confidentiality to his patients and his privacy statement to patients is in full compliance with the law. His computers and vendors are all HIPAA compliant. His attorney assures him that his office is now HIPAA compliant.

Providence, R.I.-Access to dermatologists by many patients who most need the care-the indigent-is so critically limited that a solution to the problem must be found, concludes a study presented at the recent meeting of the Society for Investigative Dermatology.

Rates double; claims rise; some doctors ‘go bare’; specialty faces new scrutiny

Dr. Brad has one of the more successful dermatology practices in his area. Although he has a computerized office, his staff in the past only used the computer for billing and scheduling purposes.

Non-genital warts continue to be almost as common as acne in the dermatology practice, according to Dr. Beutner.

Most physicians and staff feel relatively comfortable with the global surgical package - what it includes and what it doesn't. I have written numerous articles over the past several years reiterating the details of the concept so that everyone is clear about the rules that govern the global billing package.

Q & A

Dermatologists and other physicians should be aware of several key recent developments at the Centers for Medicare & Medicaid Services (CMS) that could affect their practices.

Outsourcing can offer a practicethe necessary support so physicians and staff can remain focused on patients while experts help manage the bottom line.

Providence, R.I. - Mohs surgery appears to be a more cost-effective strategy for the treatment of facial nonmelanoma skin cancers (NMSCs) compared with traditional surgical excision, although the advantage of Mohs surgery is sensitive to the type of repair performed, according to the results of a study presented by Tracy L. Bialy, M.D., M.P.H., at the annual meeting of the Society for Investigative Dermatology

Botox injections may help ease stubborn pain in the neck and upper back when other treatments fail, preliminary research shows. A study of 25 patients whose chronic pain had resisted other therapies found that a single round of Botox injections coupled with physical therapy brought pain relief within a month.

Don't complain, just do something

Trying to get out from under coverage denials, late payments, and mountains of paperwork

Treatment of hyperhidrosis with botulinum toxin injections or iontophoresis might be covered by insurance, but receiving reimbursement depends on obtaining pre-certification and using the correct billing codes, said Dr. Ramsey F. Markus, M.D.

Prescription drug makers will be required within two years to put bar codes on packaging in an effort to reduce potentially dangerous dispensing errors in hospitals, U.S. health officials said. The bar codes are meant to enable nurses and other healthcare workers to electronically verify that they are giving the right drug at the right dose at the right time. The Bush administration published a final regulation on the bar-coding requirement in February. Under the requirement, each bar code must contain a drug's unique identification number. Companies also may include information on the product's lot number and expiration date. A nurse using the system would scan a patient's identification bracelet and then the drug label, and then a computer would compare the information. An error message would appear if the drug, dose, or time of dose were incorrect.

Before adding an allied health professional to your practice, keep in mind these practical suggestions from four practice management experts on how to identify and attract prime candidates:

We get many questions about issues that do not warrant an entire column in response. Many of these are asked over and over again. I have collected these and will dedicate the next few months to answering them. I refer to these as "Dermatology Potpourri". Enjoy!