AgentAI for Dermatology
Dermatology billing that counts every lesion.
Dermatology specialists and AgentAI agents trace every exam, lesion, specimen, biopsy, destruction, excision, Mohs stage, drug authorization, claim, payer response, and patient balance — across every provider and location. Built from dermatology billing, not adapted to it.
We’ve seen your denials before
Dermatology doesn’t leak like other specialties. It leaks in lesion counts, specimen handoffs, and benefit boundaries.
Measured across the dermatology practices we bill — 90 days of real payer responses, spring 2026. These are the denials our agents are built to prevent:
Same-day E/M with a procedure
Same-day E/M billed alongside a procedure needs documentation that separately identifies the work. Miss it and the visit is denied; force it and the practice is an audit target.
Flagged with the evidence before the claim leaves — certified coders decide.
Biopsy, destruction, excision, repair
Biopsy vs excision mis-selected against the pathology report (11102/11104 vs 11400+), destruction units under-billed across multiple lesions, and repair linkage lost between the procedure and the claim.
Lesion, site, size, diagnosis, procedure, and repair linked end-to-end.
Mohs stages, blocks & pathology
Mohs stages (17311–17315) billed without complete specimen identity, blocks, and same-physician surgery-pathology evidence — the documentation gaps that invite clawbacks.
Lesion → stage → block → specimen → pathology → repair reconciled, reviewer on exceptions.
Biologics, injections & authorization
Medical-vs-pharmacy benefit confusion, step-therapy misses, expired authorizations, and dose/unit mismatches on high-cost office-administered drugs.
Authorization and claim alignment tracked per case; mismatches surfaced for review.
Medical vs cosmetic patient-pay
Cosmetic services billed to insurance, or medically indicated treatment written off as cosmetic — with ABNs, estimates, deposits, packages, and refunds tangled between them.
Insured medical and cosmetic self-pay kept visibly separate, each with its own owner.
Rejections, record requests, quiet balances
Clearinghouse rejections ignored, payer record requests aging to their deadlines, underpayments posted as correct, and patient balances with no owner and no next action.
Every exception owned — last action, next due date, amount at risk, outcome.
What we handle
Where we’ve acquired elite billing companies, their veteran billers oversee the agents — and the agents learn your specialty from millions of real paid claims. Lesion counts, biopsy & destruction families, path specimens, Mohs stages.
See what you’d keepThe rule library
Dermatology rules, applied by agents — governed by certified coders.
What the acquired dermatology team brought onto the platform:
Every rule carries its source and effective date. Payer, jurisdiction, and setting noted where relevant; superseded guidance stays distinguishable; every correction records the human decision behind it.
Measured on dermatology claims
The platform numbers, with cohorts attached.
Who runs it
The dermatology billing company we acquired works only in dermatology revenue operations — certified dermatology coding specialists whose judgment trains and supervises our agents.
Procedure-heavy dermatology runs on lesion-level documentation, specimen and pathology handoffs, code-specific global rules, authorization, and a clean separation between insured medical care and cosmetic patient-pay. Agents run the checks around the clock; certified dermatology coders make the judgment calls — modifier calls, Mohs reconciliation, biologic authorizations — with the documentation attached.
Dermatology expertise, immediately
Dermatology judgment behind the agents.
Not a call center. The dermatology specialists who joined AgentAI work only in dermatology — the agents just took the busywork off their desks.
Founded the dermatology billing company we acquired, after building and selling a multispecialty RCM company in 2014 and later managing practices for two New York City Mohs surgeons. Thirty-plus years of combined team experience in dermatology revenue operations.
Experience across lesion procedures, repairs, modifiers, global periods, Mohs, pathology, APP billing, and audits. Owns rule approval, escalation, and correction review — agents flag and surface; these people decide.
Questions dermatology practices ask
Do we need to replace our EHR, PM, or clearinghouse?
No. We connect to what you already use and work as an extension of it — the scan itself is read-only under a signed BAA. System and clearinghouse continuity is confirmed during scoping for your specific setup.
Can the scan start with one provider, site, or service line?
Yes — Mohs-only, one location, or one payer. The path is built for bounded starts: scope, scan, review, pilot, validate in parallel, then controlled expansion.
Who reviews modifier-25 and same-day E/M calls?
The certified dermatology coding specialists. Agents flag encounters where documentation may not support separate payment — people decide, with the evidence attached. That’s how supported revenue gets found without creating repayment risk.
How do you handle biologics and prior authorizations?
Authorization status, approved product, dose, units, effective and expiration dates, site of care, and claim alignment are tracked per case. Mismatches surface for review; authorization alone is never treated as a payment guarantee.
How do you keep cosmetic and medical workflows separate?
As two lanes with separate owners, amounts, patient communication, and reporting: insured medical (eligibility → documentation → claim → payer response → patient responsibility → payment) and cosmetic self-pay (estimate → consent → deposit/package → service → balance/refund → payment).
What do you do about payers downcoding our visits?
Downcoding is now routine — our specialty billing leadership sees roughly three in four payers reducing levels, most often a level 4 office visit paid as a level 3. Downcoded lines are flagged rather than written off: the record supporting the billed level is assembled and the claim is appealed with the notes attached. Recovery depends on the documentation and the payer’s rule; nothing here guarantees payment.
How do we know we are being paid our contracted rate?
Every payment is checked line by line against the fee schedule in your provider contract, not against a national average. Underpayments and silent fee-schedule changes surface as a worklist showing expected amount, paid amount, and the difference per claim — so they can be appealed or renegotiated instead of quietly absorbed.
What reporting do we get, and can we compare ourselves to peers?
Readable dashboards on the KPIs that decide a practice’s cash: days in A/R, clean-claim rate, denial rate and reasons, net collection rate, and payment velocity — broken out per provider, location, and payer. Where our books carry enough comparable dermatology volume, we show how your numbers sit against that peer cohort rather than against a national benchmark.
Who do we actually talk to when something goes wrong?
A named account team you reach directly — no ticket queue, no phone tree, and no escalation handed back to your front-desk staff to chase. The same specialty billers who work your claims are the people who answer, which is why they can answer without reading from a script.
See what your dermatology billing is leaking.
Free 90-day Dermatology Revenue Leak Scan — read-only, in plain English. Your own E/M patterns, lesion and specimen reconciliation, authorization gaps, and aged no-response, with dollars attached.
Run a Free Revenue Leak ScanSources: coding practices reflect the dermatology billing company we acquired and rules its certified specialists apply. Stats: measured on live platform books (podiatry cohorts, labeled per stat); your dermatology cohort comes with the Leak Scan. The downcoding prevalence figure reflects our specialty billing leadership’s observation across the books we operate, not a published study. Peer comparison is offered only where our books hold enough comparable volume in your specialty. Coverage depends on the record and payer; nothing here guarantees coverage or payment. Not a guarantee of results.