A Louisiana dermatology schedule mixes local patients with people who spent the morning in the car. Clinics line the I-10 and I-12 corridor through Lake Charles, Lafayette, Baton Rouge, and New Orleans, with a second concentration around Shreveport and Bossier City and smaller groups in Monroe, Alexandria, and Houma, while patients travel in from parishes that have no dermatologist at all. When a visit is rescheduled because an authorization was never on file, that patient loses another half day and the practice carries the charge for another month.
We keep authorization requirements current plan by plan, because those rules follow the payer rather than the state. Biologics for psoriasis and atopic dermatitis, Mohs surgery, and photodynamic therapy each carry conditions that shift by carrier and by year, and the plan mix in the New Orleans metro is not the plan mix in the northern parishes. A clinic seeing commercial, Medicare, and Medicaid managed care patients in one afternoon is working from several rulebooks, so we work them too.
Coding carries its own recurring traps: an E/M billed with a same-day procedure, separate lesions treated as one, excision sizes recorded after the specimen is off, pathology that has to line up with the diagnosis on the claim it supports. We would rather stop one of those than win it back on appeal, so what we learn in other markets gets written into how we code and scrub before anything is submitted. Across the practices we bill, that discipline produces a 98% net collection rate.