Dermatology Billing Services From 5.0%: Mohs, Biopsies

Who our dermatology billing service is for

We bill for independent medical dermatology clinics, Mohs surgeons, dermatologic surgery groups and practices that also run a cosmetic side, from a solo dermatologist to a group of 6–15 clinicians.

Hand your billing to us when:

• The biller left, and signed procedure notes are piling up unbilled.
• Excision and Mohs claims sit waiting on pathology while their filing clocks run.
• Repairs, flaps or added Mohs stages come back paid short.
• The current billing company stopped answering, or you cannot see which denials it worked.
• A new dermatologist, PA or NP joins and payer enrollment has not started.

What we take over and what your practice keeps

We take over dermatology billing from the signed procedure note and pathology report to the posted payment and the correct patient balance. We check every code against your clinician's documentation and never change a code without the clinician's sign-off. Our documentation-based coding review checks lesion type, body area, excised diameter and lesion count against each note. Our denial management team works every denial to a resubmission, an appeal or a documented fix.

Read the workflow as text

1. Map your MAC's policies — Pull your MAC's Mohs and benign-lesion policies before the first claim. Owner: Our billing team.
2. Match note to charge — Tie every scheduled biopsy, excision and Mohs case to a signed note. Owner: Our billing team.
3. Link the pathology — Hold excision and Mohs charges until each report matches its lesion site. Owner: Our billing team.
4. Confirm code changes — No code changes without the dermatologist's sign-off on the note. Owner: Your dermatologist.
5. Submit and post — Claims out within 1 business day; remittances posted within 2 business days. Owner: Our billing team.
6. Work denials, report — Denials worked within 2 business days; KPI report by the 10th of each month. Owner: Our billing team.

Where dermatology practices lose revenue, and what we do about it

Dermatology revenue leaks where one visit holds several services, such as an exam, two biopsies and an excision, and where excision and Mohs claims wait on pathology. We check each point below on every dermatology claim, against the bundling edits in the 2026 NCCI Policy Manual, chapter III.

Biopsy, excision and repair claims we check

• An exam billed beside a biopsy or excision. Medicare pays a same-day exam separately only when the note documents a significant, separate service (CMS Pub. 100-04, chapter 12, section 40.1). We add modifier 25 only where your dermatologist documented that exam.
• A biopsy or repair billed against the wrong lesion. A biopsy of the lesion excised that day is part of the excision, while intermediate and complex repairs may be reported on their own when medically reasonable and necessary (NCCI chapter III). We match every biopsy and repair to its lesion site and query any note missing the excised diameter.
• Several lesions treated in one session. Medicare reduces payment on the second and later procedures in a session (chapter 12, section 40.6), so a short line can look correct. We post every line on its own and work any line paid below that rule as a denial; 60-Day Underpayment Check: In month 3 we compare every payment from your first 60 days against your contracted rates and appeal each underpaid line. Needs your fee schedules.

Mohs, cosmetic and pathology-held claims we check

• Mohs claims with margin pathology added. Noridian denies Mohs claims that add pathology on the margin tissue (billing article A56514). We never bill margin pathology, and we bill the repair or flap that closes the defect from its closure note.
• Benign removals denied as cosmetic. WPS treats removal of a harmless benign lesion as cosmetic unless the record documents a medical reason (LCD L35498). We check every benign removal for that reason, and pull your MAC's Mohs and benign-lesion policies before your first claim.
• Claims held for pathology past their filing limit. Medicare allows 12 months from the date of service, and other plans set their own limits (filing deadlines by payer). Every claim we hold for pathology gets a release date, not an open-ended wait.

What our dermatology billing costs

Dermatology practices pay our specialist physician rate, and it steps down as your practice grows. Clinicians are counted on the 1st of each month from the rendering NPIs we billed the month before. Your rate moves with your size band the next month, in either direction. We charge a percentage of insurance payments and 0% of patient payments, so cosmetic procedures your patients pay for at the desk never carry our fee. Setup is $0. Invoices 1–3: only percentage fees on that month's insurance payments, plus any statements or add-ons you order. Percentage fees and mailed statements are capped at 9.0% of that month's insurance payments; from invoice 4, the $400 minimum applies even in a month when the cap comes to less. See the full rate card and fee terms.

How we start: switching from in-house or another billing company

A billing switch puts two dermatology claim groups at risk: old claims near their filing limits, and excision or Mohs claims still waiting on pathology. Our first week goes to both. Go-live, when your first claims go out, comes within 5 business days of access; any unbilled backlog follows within 10 business days of access. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access. Every inherited claim within 30 days of a filing, corrected-claim or appeal deadline is worked within 5 business days of access. Starts at access; covers up to 250 claims (more gets a day-1 deadline schedule); worked means submitted, corrected, appealed or returned with the fix.

To start, your practice:

1. Signs our service agreement and the BAA.
2. Gives our team logins to your PM system and clearinghouse.
3. Gives read access to procedure notes, Mohs maps and pathology reports.
4. Sends a claim-level aging export, so near-deadline claims are worked first.
5. Joins one kickoff call with your office manager.

Use our billing handoff plan to list what your outgoing company owes you. Not ready to switch? Start with The Free A/R Deadline Map, delivered in 5 business days. Clock starts with your claim-level aging export and signed BAA; above 10 requests in a week, we confirm your date within 1 business day.

What we report each month and the guarantees behind it

Your KPI report arrives by the 10th of each month, with every metric defined in writing: clean-claim rate, denials by reason, A/R days and net collection rate.

Front-Desk Fix Sheet. Each month, your top 3 denial causes with the exact front-desk or documentation fix for each, for future visits, plus a 20-minute call with your front desk every quarter. In dermatology, that fix can be as small as recording the excised diameter.

On-Our-Watch Guarantee. If a claim misses a filing, corrected-claim or appeal deadline while it is on our watch, we pay you what it would have paid. Claims we get complete 10+ business days before the deadline; contracted rate less any copay you collected, paid automatically within 30 days of final denial; capped $10,000/month; your holds excluded.

Clock-or-Credit Guarantee. From go-live, every new claim goes out within 1 business day of complete charge data, and every denial is worked within 2 business days of posting — or $25 comes off your invoice for each late one. Mon–Fri ET business days by your system's timestamps; worked: resubmitted, appealed or returned with the fix; auto-credited; capped at monthly fee; clearinghouse outages excluded.

We publish client results only with written permission. Until we have them, judge us by the guarantees and the free Deadline Map.

Your systems, new clinicians and patient data

We work inside your existing practice-management system and clearinghouse; tell us which ones and we confirm in writing within 1 business day. See how we work inside your EHR and PM system. Every engagement starts with a signed BAA, and our team works through the logins your practice issues.

We confirm payer enrollment and effective dates for a new dermatologist, PA or NP before releasing their claims. New-Clinician Enrollment: Clinicians who join while you're a client get enrollment filed with up to 5 payers each (the payer decides), with no per-payer fee. Beyond that, Credentialing & Payer Enrollment costs $149 per payer. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet.

Common questions

How much do your dermatology billing services cost?

6.0% of insurance payments for 1 clinician, 5.5% for 2–5 clinicians and 5.0% for 6–15 clinicians, with 0% of patient payments and $0 setup. See medical billing pricing by specialty.

How should we choose a dermatology billing company?

We don't rank companies, including ourselves. Ask every candidate for four things in writing: the rate and what it is taken on, the contract and exit terms, how it bills a Mohs case with a repair, and how it handles benign lesion removals under your MAC's policy. Our billing company checklist lists the rest.

Is there a long-term contract or a cancellation fee?

No. Leave with 30 days' notice and no termination fee. Want a run-out? We keep working the claims we submitted for 90 days at your plan rate. Decline it and we charge nothing on payments that post after you leave. Notice by email; optional run-out covers claims we submitted before your exit date, at your plan rate; handover file within 10 business days of exit.

How fast can you take over our dermatology claims?

Go-live, when your first claims go out, comes within 5 business days of access; any unbilled backlog follows within 10 business days of access. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access.

Do you bill Mohs surgery with the repair or flap that closes it?

Yes. We bill Mohs stages from the Mohs note and the repair, flap or graft from the closure note; the NCCI manual lets repairs, grafts and flaps be reported with Mohs. We never bill pathology on margin tissue, which the Mohs codes already include.

Do you charge a fee on cosmetic procedures our patients pay for?

No. Your fee is a percentage of insurance payments posted on claims we submitted or worked, net of payer recoupments and refunds. We take 0% of patient payments, copays and anything your front desk collects. Cosmetic services your patients pay for directly never reach a payer, so they never enter our fee. We check every benign removal billed to Medicare for a documented medical reason.

Which EHR and practice-management systems do you work in?

We work inside your existing practice-management system and clearinghouse; tell us which ones and we confirm in writing within 1 business day. We bill from the procedure notes, Mohs maps and pathology reports already in your system, so your team keeps its software. See EHR and PM compatibility.