It is likely that most dermatology practices strive for higher rates of reimbursement. When providing medical billing services in any specialty, you should be aware of how serious the national increase in bad debt write offs is. Coupled with Medicare’s reduction in provider fees, extreme care must be taken to ensure reasonable return on investment. To avoid denials and lost revenues, it’s imperative that procedures be accurately reported and coded and that the consequences of both state and federal regulations are adhered to.
Direct Billing Laws for Dermatopathology
Direct billing laws vary from state to state. In some states the dermopathologist must be an employee, owner or partner of the practice. This means that a practice must provide such a staff member with expensive benefits like holiday pay, health insurance, retirement benefits and perhaps profit sharing. Other costs of in-house Dermatopathology include the expenses of producing necessary reports. The technical component includes creating a laboratory with equipment such as cryostats, fume hoods and slide baths. So in the states where such practice requirements are legislated, a large startup investment is most certainly necessary. Please call us at 888-727-4234 to know more about your state laws about dermopathologist.
In practices that want to avoid building a laboratory but still want to charge for professional treatment and analysis, hiring a part-time dermatopathologist can work. In this case, the outside lab bills Medicare and other third-party payers directly for technical work. The dermatopathologist must read the slides in an onsite office to avoid the Medicare anti-markup restriction and also fulfill the “Stark same building” criteria. Three salary restrictions are Stark, Medicare safe harbor rules and Medicaid’s anti-kickback law.
Awareness of government regulations and payer regulations will lead to a minimization of claim rejections and a reduction in bad debt. Anyone with a dermatology practice must be aware of the complex network of laws and regulations governing billing and provisioning of laboratory and pathology services. In many cases private payers may impose restrictive policies on these services as well.
Here are some of their main points:
1. The Association supports the right to bill for one’s own work: The ability to bill for pathology work and technical work whenever when there is a lab is essential.
2. Board certified dermatologists should continue billing for pathology work whenever they interpret their own slides. Outside reference labs should be relied upon for preparing slides outside the office. External reference labs bill for the technical work they perform.
3. Dermatologists must continue to select any qualified dermatopathologist they choose. This should include any dermatopathologist that works in the same group practice as the referring party. This should be true even for small single specialty groups. The dermatologist and dermatopathologist must work together to deliver the best care for the patient. It is necessary for the dermatologist to be able to choose the dermatopathologist with whom they work best, based upon their confidence in that dermatopathologist’s ability and their ability to communicate.
4. They cautioned against dermatopathology lab requirements interfering with the ability of dermatologists to run their own in-office labs.
They also warned against risks posed by several different lab models, including those involving outside pathology labs that markup fees for work not performed by the billing dermatology practice. This type of billing action is considered egregious by the AAD.
It’s clear that the laws surrounding dermatopathology are deep and murky, with the many fingers of governments both federal and state muddying the waters. To tread them safely, you might enlist the aid of a dermatology billing expert. This type of expertise can help you avoid costly errors and protect your hard earned revenues.
To know more about intricacies involved in Dermatology Billing with pathology please visit M-Scribe dermatology billing services or call us to talk to one of our Dermatology Billing specialists at 888-727-4234.