Healthcare — Dermatology, ophthalmology and specialty
Ancillary revenue — pathology, cosmetics, optical — with materially different margins that are rarely reported separately.
A specialty practice is several businesses sharing a waiting room: a clinical practice paid by payers, a dispensary or an aesthetics line paid by patients, and — wherever a drug has to be bought before it can be billed — a small pharmaceutical distributor carrying inventory risk. They have different margins, different working capital and, almost always, one profit and loss statement.
buy-and-bill
JW modifier
technical and professional component
place of service
ASP-based payment
case mix
dispensary margin
drug wastage
These are the terms the review uses with you. A page written for
healthcare generally would not contain any of them.
Where it concentrates here
Specific to dermatology, ophthalmology and specialty, not to healthcare generally. Each is
concentrated — a single agreement, a single code, a single account nobody reviews
— which is why a sample of the operation tends to miss it and a full pass tends to
find it. They are not findings from a named engagement.
Buy-and-bill drug purchased, held, administered and then reimbursed against a published payment formula rather than against what the vial cost, with the exposure sitting on the practice's own balance sheet in between.
Discarded drug not billed with the JW modifier, or billed without documentation that would support it, so wastage that is reimbursable is absorbed instead.
In-office pathology and the technical and professional split, where a global charge is assumed and the payer's rules for that place of service say otherwise.
Optical dispensary, injectable and retail skincare stock counted at the till and never inventoried, so shrinkage, expiry and a slow month are indistinguishable.
Provider productivity compared across clinicians whose case mix contains different amounts of ancillary work, so the ranking measures what they do rather than what they earn.
Where this data actually lives
Modernizing Medicine EMA, Nextech or Compulink in dermatology and aesthetics; RevolutionEHR, Eyefinity/OfficeMate or Nextech in ophthalmology and optometry
A dispensary or retail point of sale that does not share inventory with the clinical system
A distributor account whose invoices reconcile to administrations only if somebody performs the reconciliation
Quality reporting prepared once a year through a registry, from data nobody looks at in between
Named because it changes what the intake asks
for. An extract from one of these has known gaps, and the review is built around them
rather than surprised by them.
The proposal is written for healthcare as a
whole — the sequence, what we would need from you, and what it costs for your
number of operating units. What is on this page is what we would additionally expect to
find in dermatology, ophthalmology and specialty.