Dermatology billing in Michigan
Derm-only coders, WPS rule coverage, and a denial playbook built for Michigan payers — not a generic billing pool.
- Medicare contractor
- WPS
- Clean claim rate
- 98.4%
- Average days in A/R
- 21 days
The Michigan challenge
BCBSM edits diverge sharply from Medicare on excision sizing.
Our play against it
Excision measurement capture at the point of care.
The complete process
How we bill a Michigan dermatology claim, end to end.
- Step 01
Eligibility & benefits, before the visit
Every scheduled patient is verified 48–72 hours ahead against the state's Medicaid plan, Medicare Advantage product, or commercial plan — including derm-specific benefit limits and prior-auth flags for biologics and phototherapy.
- Step 02
Charge capture from the derm note
Certified derm coders read the operative and pathology notes, not a superbill checkbox. Lesion counts, excision measurements, Mohs stages, repairs, and E/M with modifier 25 are coded exactly as documented.
- Step 03
Pre-bill scrub against local rules
Claims pass a state-level edit set built on the MAC's LCDs plus each in-state payer's quirks before they ever leave — NCCI bundling, frequency limits, POS accuracy, and medical-necessity narratives.
- Step 04
Clean submission & payer tracking
Daily electronic submission with acknowledgment reconciliation. Nothing sits unbilled past five days, and prompt-pay clocks are tracked so late payers get chased with interest where state law allows.
- Step 05
Denials, appeals & underpayments
Every denial is worked within 48 hours with a root-cause code. Appeals use state- and payer-specific templates, and payments are reconciled line-by-line against your contracted fee schedule.
- Step 06
Monthly reporting with your manager
A named account manager reviews clean-claim rate, days in A/R, denial categories, and provider-level productivity with you — plus what changed in your state's rules that month.
What we bill for Michigan practices
- Mohs surgery staging, repairs, and closures
- Benign and malignant excisions with measurement capture
- Destruction and AK lesion-count accuracy
- Dermatopathology TC/26 and global splits
- Biologics and phototherapy prior authorization
- E/M with modifier 25 documentation defense
- Cosmetic vs. medical self-pay separation
- Credentialing, revalidation, and new-site enrollment
Onboarding in Michigan
BAA signed and systems access on day one, legacy A/R triaged in week one, and your first clean-claim batch out the door inside two weeks — with WPS and local plan rules loaded before we bill a single encounter.
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