Practice management A to Z
Learn how coding, medication access, technology, staff wellness, and more can impact your practice.
One of the biggest difficulties in managing a dermatology practice is getting medication to patients, and one of the biggest barriers in this process is the growing number of prior authorization requirements from insurance companies.
Martina Porter, MD, FAAD, vice chair for research and academics in the department of dermatology at Beth Israel Deaconess Medical Center in Boston, said the whole process has become more arduous in recent years. Dr. Porter spoke about this challenge during Thursday’s session, C001 – Navigating Practice Management in Dermatology: Insights and Innovations. The course was led by session director George Han, MD, PhD, FAAD, and co-director Alexandra Flamm, MD, FAAD.
Medication mania
The burden of prior authorizations has even spread to generic medications like inexpensive topical steroids, Dr. Porter said.
“Unfortunately, over the years, I am seeing a greater burden in the number of medications that require prior authorizations as well as an increase in the requirement for appeals for prior authorization denials — not to mention longer wait times to review the appeals,” she said. “The time to do these authorizations is now often a greater cost in staff time than the cost of the medication itself.”
Those barriers don’t stop at the insurance company level either, according to Dr. Porter.
“For specialty medications, such as biologics, there are also additional barriers at the pharmacy level where the pharmacy will not dispense medications with an active prescription and approved prior authorization,” she said. “Tactics they use include requiring that a physician or pharmacist re-verify the prescription, or the pharmacy will tell the patient they do not have an active prior authorization on file but will tell the physician the patient has not requested delivery.”
At Beth Israel Deaconess Medical Center, Dr. Porter said a structure has been put in place that includes a centralized pharmacy, an additional pharmacist, and two full-time pharmacy technicians who are devoted to dermatology alone. Although this has helped improve patient access and prescription fulfillment times at her organization, she said it is not feasible for most practices.
“But there are many new alternatives, including working directly with specialty pharmacies who will pursue prior authorizations with the incentive of being able to dispense the prescriptions to patients,” she said.
Artificial intelligence is making inroads in this area as well, with various companies using AI tools to assist in the process. Dr. Porter thinks this could go even further on both sides of the equation in the near future.
“I expect this will ultimately turn into an AI-assisted prior authorization from a practice that goes to an AI-assisted insurance representative to evaluate the prior authorization,” she said.
Another potential solution is in the form of alternative pharmacies like Amazon that offer lower prices on some medications, such as topical retinoids, without a prior authorization.
“This is a good incentive for the dermatology practice and patient, but it does raise the possibility that dermatologist follow-up visits are replaced by an Amazon-associated virtual provider for refills,” said Dr. Porter.
Coding updates
This year has come with a wave of updates in terms of dermatology coding, especially when it comes to surface radiation therapy (SRT). Session presenters Alex Miller, MD, FAAD, and Faith McNicholas, AAD senior manager of coding and reimbursement, said CMS has implemented specific coverage limitations and exclusions may differ from those of other payers.
“For example, CMS states that current procedural terminology (CPT) code 77436 [for SRT] should not typically be reported multiple times during the treatment course unless there is clear medical and/or no clinical justification,” said McNicholas. “In addition, CMS considers the use of ultrasound [CPT code 77439] during the delivery of SRT to be not medically necessary and, therefore, not a covered service.”
Dr. Miller, a dermatologist at the Skin Cancer and Reconstructive Surgery Center in Yorba Linda, California, said that although coding guidance may support the use and reporting of ultrasound in certain circumstances, the coverage ultimately depends on the individual payer policy.
“Practices should not assume that CMS policies apply universally or that other payers will follow the same coverage criteria,” Dr. Miller said. “In other words, these changes are not one size fits all.”
McNicholas said the AAD recommends that practices review each payer’s coverage policies, utilization guidelines, and billing requirements before reporting these services to ensure compliance and maximize reimbursement. She also recommended checking the coding resources found online in the Academy’s Practice Management Center.
Teledermatology
In addition to online resources, technology advances, such as teledermatology and artificial intelligence (AI), can be used to help improve the practice workflow as well as overall patient outcomes and satisfaction.
Session presenter Elizabeth Jones, MD, FAAD, associate professor of dermatology at Thomas Jefferson University Hospital in Philadelphia, said teledermatology demand is currently being driven by reduced costs, decreased time away from work or school, and less disruption to daily routines and obligations.
“Importantly, continuity of care and ease of follow-up, particularly for chronic inflammatory diseases, represent critical telehealth satisfaction and quality metrics on a systems level,” she said.
Dr. Jones said adding AI to your practice, such as automating the patient documentation process, can reduce the overall time dedicated to these tasks, leaving the dermatologist freer to direct efforts and energy toward patient care.
“Additional applications for AI include triage, prior authorization management, image quality assessment, scheduling optimization, and inbox management,” said Dr. Jones. “Collectively, these tools have the potential to reduce administrative burden, one of the primary drivers of physician burnout, while improving both patient and physician satisfaction.”
Well-being for all
Even with those tools, physician burnout can still be an issue. Session presenter Brad Glick, DO, MPH, FAAD, a dermatologic surgeon with Skin and Cancer Associates in Margate, Florida, said physician and staff well-being are directly linked to quality of care, patient satisfaction, retention, and safety.
“Dermatology practices should implement sustainable scheduling models, team-based care, administrative burden reduction, and proactive mental health resources,” he said. “A healthy workforce is essential to delivering exceptional patient outcomes and maintaining long-term practice viability.”
In addition to wellness, Dr. Glick said dermatology practices must foster an atmosphere of inclusivity to ensure diagnostic accuracy and therapeutic access across all skin types, ages, genders, socioeconomic groups, and cultural backgrounds.
“Wellness, diversity, and safety are no longer separate initiatives,” he said. “Together, they represent the foundation of high-quality, patient-centered dermatologic care and are increasingly recognized as critical drivers of clinical excellence, patient outcomes, workforce sustainability, and health care equity.”
