Dermatology revenue cycle management
Two businesses under one roof - the cosmetic-vs-medical coding line is the biggest audit risk, and biologics are the biggest PA burden. AI agents keep both clean across the whole cycle.
Dermatology mixes medical and cosmetic work with procedure-heavy coding and expensive biologics. AI agents keep the cosmetic-vs-medical line clean, get modifiers right on lesion removals and Mohs, assemble biologic authorizations, and run claims, posting and denials behind it. Teledermatology is covered too - telehealth visits are billed with the correct place-of-service and modifiers, and the same AI agents handle their eligibility, claims and follow-up.
Coding & compliance
- Cosmetic-vs-medical flagging - Flags cosmetic services documented as medically necessary and holds the boundary.
- Procedure coding & path correlation - Codes biopsies, excisions and Mohs, correlating with pathology results.
- Modifier accuracy - Validates modifiers 25 and 59 on same-day services.
- Lesion & specimen reconciliation - Reconciles lesion count and size with specimens submitted and billed.
- E/M + procedure same-day coding - Supports a significant, separate E/M billed with a same-day procedure.
Prior authorization (biologics)
- Biologic PA assembly & renewal - Assembles step-therapy documentation and prior-treatment history for biologics (e.g., Dupixent), and tracks renewals.
- Payer-policy matching - Checks the encounter against payer criteria before submission.
- Specialty-pharmacy coordination - Runs the benefit investigation and coordinates the specialty pharmacy.
- Copay-assistance / PAP enrollment - Enrolls eligible patients in copay-assistance and patient-assistance programs.
Eligibility & the cosmetic/medical split
- Eligibility & benefits - Verifies coverage and out-of-pocket for medical services.
- Cosmetic vs. medical at booking - Flags cosmetic vs. medical at booking time to prevent collections issues later.
- Cosmetic cost estimate - Produces a self-pay estimate for cosmetic services up front.
Claims & submission
- Claim scrubbing & NCCI edits - Scrubs claims against bundling and payer edits.
- Pathology claim reconciliation - Reconciles professional and technical pathology components.
- Claim status follow-up - Polls status and chases stuck claims.
Payments, denials & AR
- ERA auto-posting - Posts remittances and adjustments automatically.
- Medical-necessity & lesion-removal appeals - Auto-drafts appeals for lesion-removal and medical-necessity denials.
- Underpayment detection - Flags payments below contracted rates.
Patient collections
- Cosmetic pre-payment & self-pay collection - Collects cosmetic payment before service.
- Statements & payment plans - Sends statements and offers self-service payment plans.
Front office
- Recall & skin-check reminders - Drives annual skin-check recall and reactivation.
- Call answering & booking - Answers calls and books into EMA/ModMed or Nextech.
Analytics
- Cosmetic vs. medical revenue mix - Dashboards the cosmetic/medical revenue split and denial trends.
What you get
- Keep the cosmetic-vs-medical line clean and audit-safe
- Get modifiers 25 and 59 right, every time
- Correlate coding with pathology automatically
- Speed biologic prior auths with auto-assembled step-therapy docs
- Verify coverage before medical procedures
- Recover lesion-removal denials fast
Frequently asked questions
When do you use modifier 25 and 59 in dermatology?
Modifier 25 is used when a separately identifiable E/M service is performed on the same day as a procedure, and modifier 59 identifies a distinct procedural service that would otherwise be bundled. Both are heavily audited, so documentation must support the separate work.
How is Mohs surgery billed?
Mohs is billed by stage and by the number of tissue blocks per stage, using dedicated codes that already include the pathology interpretation. Reporting a separate pathology charge for the same tissue is a common and costly coding error.
How do you separate cosmetic from medical dermatology?
By the medical indication and supporting documentation. Cosmetic procedures are patient-pay; medically necessary procedures - lesion removals, biopsies, medical treatment of skin disease - are billable when the diagnosis and rationale are documented at the time of service.
Why do dermatology biologics need prior authorization?
Biologics for psoriasis, eczema and other chronic skin disease are high-cost drugs, so payers require prior authorization and usually step therapy - documented failure of preferred treatments first. Assembling that documentation up front is what gets the authorization approved.