Medical Billing for Dermatology professionals is vastly complex and requires a highly trained staff to help ensure accurate and timely reimbursement.
According to a survey by the Health Insurance Association of America of private insurers’ health care fraud investigations, overall health care fraud activity broke down as follows:
1. 43% – Fraudulent diagnosis (like stating the lesion is a skin cancer and billing an excision of a malignant lesion when the pathology report shows a benign lesion)
2. 34% – Billing for services not rendered (this includes misrepresenting the provider of care)
3. 21% – Routine waiver of patient deductibles and co-payments
4. 2% – Other
For Medicare, the most common forms of fraud include:
1. Billing for services not furnished as billed (this includes medical record documentation that does not support the service(s) being billed and up-coding)
2. Misrepresenting the diagnosis to justify payment (using a diagnosis that is not covered with a diagnosis that is covered)
3. Soliciting, offering, or receiving a kickback (this applies most in pathology related charges)
4. Misrepresenting the provider of care (such as in incident to scenarios or billing under the name of one physician for services provided by another physician who is not yet credentialed)
5. Misrepresenting the place of service
6. Unbundling or “exploding” charges (misuse or abuse of the modifier 59)
CBS will manage all aspects of your dermatology practice’s billing to help ensure you receive proper compensation for services rendered.