For dermatologists performing surgical procedures, revenue opportunities can extend beyond the physician’s professional claim. When qualifying procedures are performed in an appropriately structured and accredited procedural room, there may be an opportunity for a separate facility component in addition to professional reimbursement.
Importantly, this does not necessarily mean developing a traditional surgery center or building a separate facility. Depending on the procedures being performed, applicable accreditation standards, state requirements, and payer requirements, an existing office may be able to establish an appropriately equipped and accredited procedural room within its current space.
CLEAR Management Group helps physicians navigate this process—from evaluating the procedural space and managing accreditation to establishing the dermatology revenue cycle management processes needed for facility billing.
How Did CLEAR Help a Dermatologist Create a New Facility Revenue Opportunity?
CLEAR worked with a dermatologist who was already performing surgical procedures within the existing office.
Rather than focusing on increasing patient volume or building a traditional surgery center, CLEAR identified an opportunity to change the structure surrounding procedures the physician was already performing.
The solution did not require opening a traditional freestanding ASC. CLEAR helped the dermatologist establish and accredit an appropriate procedural room within the existing location and guided the team through the accreditation process.
Once the appropriate procedural and facility structure was established, qualifying procedures could potentially generate a facility claim in addition to the physician’s professional claim, subject to payer requirements, patient benefits, and other applicable billing requirements.
For certain qualifying procedures, the financial impact was substantial.
In some cases, collections associated with the new facility structure exceeded 10 times the revenue previously generated when the procedures were performed under an office-only reimbursement model.
The dermatologist did not need 10 times as many patients or 10 times as many procedures.
The opportunity came from creating the appropriate accredited procedural structure around services the physician was already providing.
From an Office Procedure Room to an Accredited Procedural Room
Accrediting a procedural room does not necessarily mean transforming a dermatology office into a traditional surgery center.
Depending on the procedures performed and applicable requirements, accreditation may involve designating and preparing an existing procedural room within the physician’s current location to meet the appropriate clinical, safety, operational, and accreditation standards.
CLEAR guided the client through this process, including:
- Evaluation and preparation of the procedural space
- Development of policies and procedures
- Accreditation application and preparation
- Compliance documentation and required logs
- Quality improvement programs
- Staff and physician preparation
- Mock surveys
- Procedural room readiness
- Survey preparation and support
Following the accreditation process, the dermatologist described working with CLEAR Management Group as the “single best decision” made in preparing for accreditation.
The physician specifically highlighted CLEAR’s hands-on approach, organization, staff preparation, and ability to make a potentially overwhelming accreditation process manageable.
Most importantly, the dermatologist was able to continue performing procedures within the existing location while establishing an accredited procedural environment that could support additional facility reimbursement opportunities for qualifying procedures.
Why Facility Billing Matters for Dermatology Procedures
Dermatology can extend well beyond routine office visits and minor in-office treatments. Dermatologists may perform a range of surgical and reconstructive procedures, including skin cancer excisions, wide local excisions, complex wound closures, adjacent tissue transfers, skin grafts, lesion removals, scar revisions, and other reconstructive procedures.
Depending on the procedure, clinical circumstances, accreditation standards, and other applicable requirements, certain cases may be appropriate for an accredited procedural room.
For qualifying procedures performed within the appropriate accredited setting, the revenue cycle may involve:
- Facility reimbursement
- Physician professional reimbursement
- Anesthesia reimbursement, when applicable
- Verification of out-of-network benefits
- Patient deductibles, coinsurance, and other responsibility
- Authorization requirements
- Denial and underpayment recovery
- ERISA appeals for qualifying employer-sponsored health plans
This is fundamentally different from traditional physician-office billing. A dermatology procedure performed within an appropriately structured accredited environment may involve multiple claim components, payer requirements, and reimbursement opportunities that need to be evaluated and managed separately.
CLEAR’s focus is on this procedural and facility revenue cycle—helping clients understand benefits before the procedure, appropriately submit the applicable facility claim, monitor reimbursement, identify denials and underpayments, and pursue additional reimbursement through the appropriate appeal process when warranted.
For dermatologists already performing surgical procedures in their offices, the opportunity may not require more patients, more procedures, or the development of a traditional ASC. It may begin with evaluating whether the procedures they already perform and their existing procedural space could be appropriate for an accredited facility model.
Why Should Accredited Dermatology Facilities Review Denied and Underpaid Claims?
Submitting the claim is only the beginning of the revenue cycle.
For accredited procedural facilities—particularly those working with out-of-network benefits—a denial or reduced payment should not automatically be treated as the final reimbursement determination.
CLEAR reviews claims to determine why payment was reduced or denied and what options may be available for further review.
Depending on the circumstances, this can include evaluating:
- Verification of benefits information
- Patient plan provisions
- Claim processing
- Coding and documentation
- Medical necessity issues
- Payer reimbursement methodology
- Underpayments
- Denial reasons
- Appeal rights
- ERISA protections when applicable
This becomes particularly important with higher-value facility claims, where even a relatively small number of improperly denied or underpaid claims can have a significant financial impact.
How Can ERISA Appeals Support Out-of-Network Dermatology Facility Claims?
For qualifying employer-sponsored health plans, ERISA may provide important rights and protections when a claim is denied or underpaid.
CLEAR’s ERISA appeals process goes beyond simply resubmitting a claim or sending a generic appeal letter.
When applicable, our team evaluates the individual claim, patient benefits, plan language, EOB, medical documentation, and relevant appeal rights to develop a customized strategy.
For an out-of-network accredited procedural facility, this can be an important part of the revenue cycle.
Our objective is not simply to get a claim processed. Our objective is to determine whether the reimbursement is appropriate and, when it is not, whether additional reimbursement can be pursued.
What Should Dermatology Facility Revenue Cycle Management Include?
A comprehensive revenue cycle strategy for an accredited dermatology procedural facility may include:
- Verification of out-of-network benefits
- Prior authorization
- Facility claim submission
- Coding and documentation review
- Payment posting
- Accounts receivable follow-up
- Denial management
- Underpayment identification
- ERISA appeals when applicable
- Payer reimbursement analysis
- High-dollar claim follow-up
- Revenue cycle reporting
- Accreditation and compliance support
These services should work together.
For example, understanding a patient’s out-of-network benefits before a procedure can directly affect how the facility approaches the claim afterward. Similarly, identifying payer trends across multiple claims can reveal reimbursement issues that would be difficult to recognize by looking at claims individually.
Are You Maximizing the Facility Revenue From Procedures You Already Perform?
For dermatologists already performing surgical procedures within their offices, the question does not necessarily need to be:
“Should I build a surgery center?”
A better question may be:
“Could the procedural space I already have be appropriately accredited, and could qualifying procedures create an additional facility reimbursement opportunity?”
That is where CLEAR Management Group can help.
We work with physicians to evaluate their existing procedural environment, understand accreditation requirements, prepare the space and team for accreditation, and establish the facility revenue cycle processes necessary to appropriately bill qualifying procedures.
Our dermatology client did not need to dramatically increase patient volume or open a traditional freestanding surgery center to create a significant financial change.
Instead, CLEAR helped identify an opportunity within procedures the physician was already performing and assisted in establishing the accredited procedural structure and revenue cycle process needed to pursue appropriate facility reimbursement.
CLEAR Management Group: Accreditation and Dermatology Revenue Cycle Management for Procedural Facilities
CLEAR Management Group is not a traditional physician-office billing company.
Our focus is on accredited procedural facilities, surgery centers, facility reimbursement, and the more complex revenue cycle challenges associated with procedural and surgical claims.
For dermatologists, that may begin with something much more approachable than developing a traditional ASC: evaluating whether an existing procedural room can be appropriately structured and accredited for the procedures already being performed.
From accreditation preparation and compliance to verification of benefits, authorizations, facility billing, collections, denial management, and ERISA appeals, CLEAR can help manage the process from beginning to end.
If you are a dermatologist already performing surgical or reconstructive procedures within your office, CLEAR can help evaluate whether your current procedural environment may present an accreditation and facility reimbursement opportunity.
Contact CLEAR Management Group to learn whether the procedures you already perform and the procedural space you already have could support an accredited facility model and additional facility reimbursement opportunities.
