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Case studies

Anonymized dermatology billing case studies

Real engagements, described by practice profile rather than by name. Each one shows the problem we found, what we changed, and the direction the numbers moved.

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4-provider Mohs and general dermatology group, Southwest

Mohs practice cut surgical denials after repair coding rebuild

Staged Mohs cases were being submitted with incorrect block counts and repairs bundled into the excision, so a predictable share of the highest-value claims came back denied or underpaid every month.

What we changed

  • Prospective coding review on every Mohs case before submission
  • Rebuilt modifier sequencing for same-day biopsy, excision and repair
  • Repair sizing verified against operative note anatomic site
  • Appeal templates built per payer for bundling denials

Direction of results

Surgical denial rate
down materially
First-pass acceptance
improved
Days in A/R
reduced
“The difference was not that we started billing more. It was that the cases we were already doing finally got paid correctly the first time.”
Practice administrator, anonymized client

Measurement window: First two quarters of engagement

2-location general dermatology practice, Northeast

Aged A/R recovery after a mid-year biller transition

The practice left a prior billing vendor with a large balance of claims past 120 days, much of it approaching timely filing limits with no documented follow-up history.

What we changed

  • Full A/R inventory triaged by payer, age and timely filing deadline
  • Reconsiderations filed first on claims closest to the filing window
  • Eligibility re-verified on accounts denied for coverage
  • Root-cause report delivered so the same errors did not recur going forward

Direction of results

Recovered balances
substantial recovery
Claims lost to timely filing
minimized
A/R over 120 days
reduced
“We assumed that money was gone. A meaningful share of it was not — it just needed someone to work it before the clock ran out.”
Practice administrator, anonymized client

Measurement window: 90-day recovery project

6-provider dermatology group, Southeast

Office visit coding brought in line with documentation

Providers were defaulting to a single E/M level regardless of medical decision making, leaving legitimately supported visits undercoded across thousands of encounters a year.

What we changed

  • Retrospective audit sample across all providers
  • Provider-level feedback sessions with documented examples
  • EHR templates updated to prompt MDM elements
  • Ongoing quarterly audit cadence to hold the gain

Direction of results

E/M level distribution
aligned to documentation
Audit exposure
reduced both directions
Per-visit revenue
increased
“It was never about upcoding. It was about getting credit for the work already in the chart.”
Practice administrator, anonymized client

Measurement window: One quarter to implement, ongoing audits

Medical dermatology practice with heavy biologics volume, West

Biologics authorizations moved off the clinical team

Nursing staff were spending hours each week on prior authorizations and peer-to-peer scheduling, and treatment start dates slipped when approvals lagged.

What we changed

  • Dedicated authorization queue with payer-specific criteria checklists
  • Benefit verification completed before the visit, not after
  • Peer-to-peer requests scheduled proactively on likely denials
  • Approval status visible to clinical staff without a phone call

Direction of results

Clinical staff hours on auth work
sharply reduced
Treatment start delays
shortened
Authorization-related denials
reduced
“Our nurses went back to being nurses. That alone justified the move.”
Practice administrator, anonymized client

Measurement window: 60 days from go-live

Dermatology group with in-house dermatopathology lab, Midwest

In-house pathology billing corrected on TC/PC splits

Global billing was being submitted where payers required technical and professional components split, and multiple specimens from a single encounter were being underreported.

What we changed

  • Payer-by-payer determination of global versus split billing rules
  • Specimen-level charge capture reconciled against the lab log
  • Corrected claims filed within reconsideration windows
  • Monthly reconciliation between lab volume and billed specimens

Direction of results

Specimen capture
reconciled to lab log
Pathology underpayments
corrected
Lab revenue per encounter
increased
“The lab was doing the work. The claims just were not describing it accurately.”
Practice administrator, anonymized client

Measurement window: First 120 days

Combined medical and cosmetic dermatology practice, South

Cosmetic and medical services separated cleanly at the front desk

Mixed visits produced disputed patient balances and payer refund requests, because cosmetic services were occasionally submitted to insurance and medical services were occasionally collected as cash.

What we changed

  • Service-level decision rules built with the clinical team
  • Financial responsibility forms revised and captured at check-in
  • Front-desk training on the medical-necessity determination
  • Patient statements redesigned to show the split plainly

Direction of results

Patient billing disputes
reduced
Payer refund requests
reduced
Point-of-service collections
improved
“Patients stopped calling angry, because the bill finally matched what we told them at check-in.”
Practice administrator, anonymized client

Measurement window: One quarter

Why these are anonymized

Client practices are identified by size, service mix and region rather than by name. Naming a practice alongside its collections data reveals competitively sensitive financial information, and our agreements do not treat client performance data as marketing material.

Directional outcomes are described qualitatively rather than as headline percentages, because a percentage without the underlying baseline, payer mix and time period is not evidence. On a discovery call we will walk through the underlying numbers for a comparable practice.

How to read a case study

  • Match the profile first — provider count, service mix and region drive most of the result
  • Look at the actions, not the outcome; the actions are what we would repeat at your practice
  • Ask what the baseline was, and over what period the change was measured
  • Ask what did not work, and what the practice had to change on its side

Frequently asked questions

Why are the practices not named?

Client agreements treat performance and collections data as confidential. We describe practices by size, service mix and region instead, and we can discuss a comparable engagement in detail on a call.

Can you share specific numbers?

Yes, in a discovery conversation and under an NDA where appropriate. We prefer to show numbers with their baseline and time period attached rather than publish a headline percentage without context.

Can we speak to a reference practice?

We can arrange a reference call with a practice of similar size and service mix, subject to that practice agreeing.

How long before we would see similar results?

Denial and clean-claim improvements typically show inside the first 60 to 90 days. Aged A/R recovery is a defined project with its own timeline, and coding-driven changes hold only with an ongoing audit cadence.

Free claims audit

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  • No cost, no obligation, no sales pressure
  • BAA signed before any data is shared
  • Reviewed by AAPC-certified dermatology coders

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