Biologics denials and Mohs coding errors are recoverable. Most never get worked.
High-cost injectable auth failures, Mohs surgery modifier complexity, and pathology bundling disputes cost dermatology practices more recoverable revenue than almost any other specialty. Ember catches them all.
Trusted by specialty groups and health systems
Where dermatology revenue leaks
Top dermatology denials Ember resolves
Ember addresses the recurring medical necessity, authorization, coding, and global-period issues that delay or reduce payment for dermatology care.
01 · Medical necessity
Claims deny when documentation does not distinguish medical care from cosmetic services.
Dermatology billing depends on a clear cosmetic-versus-medical classification, with Mohs and pathology documentation supporting the billed service. Ember reviews the record for the medical necessity details payers expect.
Cosmetic vs. medical · Mohs · Pathology02 · Prior authorization
Biologic treatment is delayed or denied when payer requirements are incomplete.
Biologics bring detailed prior authorization requirements that vary by payer and treatment. Ember helps teams identify required documentation and authorization gaps before they interrupt care or payment.
Biologic prior authorization03 · Downcoding and global periods
E/M levels and same-day services are reduced when documentation or modifiers do not align.
Modifier 25 scrutiny, E/M leveling, and global-period rules create recurring reductions and denials. Ember reviews the supported visit level and modifier context so teams can prevent or challenge inappropriate payment changes.
E/M leveling · Modifier 25 · Global periodsThree engines.
One source of truth.
Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer that sits on top of your EHR. Built for the biologics and procedure complexity dermatology billing requires.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every encounter and provider.
L. Alvarez
Encounter #D-58217
02 · Audit
Coding Engine
Reviews 100% of encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.
Unbundle 88305 — append modifier 59
CMS NCCI PTP · confidence 0.96
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the applicable LCD/NCD policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #D-58217 · Denial CO-97
The denied dermatopathology is separately reimbursable per CMS NCCI unbundling rules and contract §2.7…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for dermatology practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the biologics issue before the claim leaves.
Ember reviews every encounter against coding standards, payer biologics policy, and your contracts. Auth gaps, Mohs stage documentation, and pathology splits are flagged before submission.
- 1
Ingest the encounter
Pulls clinical notes, procedure codes, and modifiers from your EHR and practice management system.
- 2
Validate against rules
Checks biologics step therapy documentation, Mohs stage counts, pathology bundling rules, and modifier application against payer policy and your contracts.
- 3
Recommend with citation
Returns the suggested correction tied to the exact payer policy, LCD/NCD reference, or contract term.
- 4
Educate the provider
Coding patterns drive provider-level coaching, so biologics documentation and Mohs coding accuracy improve over time.
Unbundle 88305 — append modifier 59
CMS NCCI PTP · confidence 0.97
+23%
Clean-claim rate
100%
Encounters reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves clinical and prior-treatment records, references payer policy and contract terms, drafts the appeal, and tracks it through adjudication.
Auth not on file
Missing modifier
Pathology bundled
Step therapy
Biologics appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per appt
The full revenue cycle
From eligibility to adjudication. Covered.
Audit and appeals are the workhorses, but Ember protects dermatology revenue at every stage of the cycle.
Eligibility Verification
Confirms active coverage and biologics benefit structure before the visit, and flags formulary gaps before they become billing problems.
Prior Authorization
Checks auth requirements in real time for biologics, generates step therapy documentation, and submits to payer portals automatically.
AI Medical Coding
Reviews 100% of encounters, biologics codes, Mohs stages, and pathology charges, against national standards and payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching step therapy gaps, Mohs modifier errors, and pathology bundling before they generate write-offs.
Denial Management
Full appeal lifecycle for every denial type, auth failure, step therapy, bundling dispute, and modifier edit, tracked to adjudication.
Underpayment Recovery
Parses contracts to model what each biologics claim should pay, then surfaces line-item underpayments at scale.
Recoverable dermatology revenue, captured
-57%
denial rate
-45%
cost to collect
100%
encounters audited
3 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
- 65% less manual effort, as reported by customers
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
See what your dermatology practice is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.