When is an E/M Service Considered Separate and Distinct from a Dermatology Procedure Performed on the Same Day?
An E/M service is considered separate and distinct from a dermatology procedure when the provider performs and documents a significant, separately identifiable evaluation and management service that goes above and beyond the work normally included in the procedure. In these cases, the E/M service may be reported with modifier 25 in addition to the procedure. Importantly, CMS […]
PA & Advanced Nursing Supervision: Emerging Legal and Compliance Risks Healthcare Organizations Must Address Now
Healthcare organizations are facing accelerating legal and compliance risk as state‑level changes reshape the supervision, scope of practice, and credentialing requirements for Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs). These changes, many of which were developed and implemented during and after the COVID‑19 public health emergency, are now creating significant liability exposure for providers, supervising physicians, and employers who […]
High-Risk Liability Areas in Aesthetic and Dermatology Practices
As aesthetic and dermatology services continue to expand, so does regulatory scrutiny and liability exposure. While many procedures are viewed as routine or low-risk, the consequences of inadequate supervision, poor documentation, or scope-of-practice violations can be significant. Understanding where risk exists, and implementing safeguards to address it, are essential for protecting patients, providers, and organizations. […]
Getting Telehealth Documentation Right: 3 Details That Matter
A strong telehealth note should capture not just the clinical work, but the context of the visit. For telehealth E/M services, three simple details can make a meaningful difference for billing and compliance: how the visit happened, where the patient was, and whether the patient or guardian agreed to receive care via telehealth. 1. Modality: […]
Eliminating Preventable Denials and Mitigating Medical Necessity Challenges in Dermatology
Healthcare industry benchmarking surveys have reported that denial rates for dermatology practices average 14%, which is significantly higher than the 5% – 8% benchmark for medical practices. Following our recent presentation at the Dermatology Manager’s Association Annual Conference surrounding payer denials, one issue continues to stand above the rest: medical necessity. Many denials and payment issues are controllable and preventable, but payer denials for […]
New Immunization Counseling Codes: Added Revenue Opportunities for Pediatric Providers
The American Medical Association (AMA) has announced new CPT codes (90482–90484) for immunization counseling — offering pediatric providers a new way to capture reimbursement for valuable time spent counseling patients and families about vaccines, even when immunizations are deferred, declined, or the patient is underimmunized. These codes, detailed in the March 2026 CPT® Assistant (Issue […]
Keys to Support Medical Necessity in Dermatology (NEEDS UPDATED)
I recently spoke at high level about denials at the DMA conference, including Medical Necessity—specifically, how to defend claims when a payer alleges services fail to meet the “reasonable and necessary” standard. In FY 2025, DOJ reported record False Claims Act recoveries exceeding $5.7 billion tied to healthcare matters, with enforcement heavily focused on medically unnecessary or substandard care, […]
Important Update: New Medicare Advance Beneficiary Notice (ABN) Now Approved
CMS has announced an update to the Medicare Advance Beneficiary Notice of Non-coverage (ABN), Form CMS-R-131, now approved by the Office of Management and Budget (OMB). The newly revised ABN is effective immediately and valid through March 31, 2029. The ABN helps beneficiaries make informed decisions when services or supplies may not be covered by Medicare. Providers are […]
Superficial Radiation Therapy 2026 CPT Code Overhaul: An Updated Guide for Dermatology Practices
The landscape for billing and coding Superficial Radiation Therapy (SRT) is undergoing a significant shift. With the 2026 CPT code updates, the American Medical Association has completely restructured how these [...] OIG Audit Confirms: Postoperative Visit Reporting (99024) is a Top Compliance Priority
At Compass Healthcare Consulting, we closely monitor regulatory developments to help our clients stay ahead of compliance risks and issues that can impact revenue. A recent report from the U.S. Department of Health and Human Services Office [...] 