Dermatology · Illustrative example
A dermatology group lifted revenue 20% in one year
A multi-provider dermatology group had built a thriving practice over fifteen years, but success had masked a problem: they were leaving money on the table every day. Between Mohs billing errors, pathology coding confusion, and the complexity of separating cosmetic from medical revenue, the practice was hemorrhaging thousands monthly — and nobody could pinpoint where.
- 20%
- Revenue increase
- 34% → 12%
- Mohs denial rate
- 45 → 27
- AR days
- $220K
- Underpayments recovered
Illustrative example — a representative scenario, not a specific client.
Three locations, eight providers, everything from routine skin checks to complex Mohs procedures. On the surface, an 89% clean-claim rate looked acceptable. Beneath it, denials were concentrated in the highest-value services, and the practice manager was spending 15+ hours a week manually reconciling cosmetic versus medical billing.
Mohs was the largest single problem. Mohs requires precise coding across CPT 17311–17315 depending on stages and anatomic location. The billing staff frequently misapplied these codes or failed to document stage progression. Over four months, Mohs-related denials represented 34% of all rejections despite being only 12% of claims.
Pathology coding compounded it. Every Mohs case generates pathology work billed separately as 88305 or 88307, with modifier 26 for the professional component or TC for technical. Nobody on staff could distinguish them reliably. The practice was recovering only 78% of expected pathology revenue.
We installed a Mohs-specific workflow. Stage-by-stage documentation templates built into the encounter. Billing rules engine that caught missing modifiers before submission. A coder dedicated to dermatology who had coded Mohs for seven years — not a generalist.
For cosmetic/medical separation, we implemented a two-encounter model for mixed visits — not at the provider level (where it felt like administrative burden) but at billing time, where the correct splits could be made systematically using the documentation captured.
Pathology billing moved to a clean split-billing workflow, with TC and 26 modifiers applied correctly at submission. Aged underpayments got triaged and appealed — $220K in previously-written-off pathology underpayments recovered in the first four months.
Year-over-year revenue up 20%. Mohs denial rate from 34% to 12%. Pathology recovery rate from 78% to 96%. AR days from 45 to 27. $220K in underpayments recovered from prior periods.
The practice manager got fifteen hours a week of her life back. She used it to rebuild the front-desk onboarding program — which had been on her list for two years.
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