Veteran dermatologist expends impressive energy working with carriers for fair pay

December 31, 2012

James A. Zalla, M.D., has affected the lives of countless patients during his 43 years of practice as a dermatologist and dermatopathologist. But what many dermatologists might not know is that Dr. Zalla has influenced their practices, too, by working for decades to help ensure fair payment for the specialty’s services.

Dr. Zalla says he’s proud to have had the opportunity to represent the American Academy of Dermatology in meetings with insurance carriers. His curriculum vitae is rich with voluntary posts related to coding and reimbursement.

Dr. Zalla is past chairman of the AAD’s Health Care Finance Committee and DERMCAC, and he continues as the dermatology representative to the Kentucky Medicare Carrier Advisory Committee. For many years, he directed or was a speaker at the AAD’s coding course. He also represented dermatology as a member of the American Medical Association’s CPT Editorial Panel and the AMA Correct Coding Policy Committee. These bottom-line issues keep him busy.

“In the late 1990s, insurance carriers began to use bundling software. As a result, some of our separate services no longer had any value, only because they happened on the same date. I confronted carriers on behalf of (AAD) members to stop this abusive practice. And one by one, following face-to-face meetings with their national medical directors, carriers began to recognize the separate service modifiers and stop their bundling practices,” he says.

Pulling no punches

Dr. Zalla continues to address reimbursement issues and is known to pull no punches. Last fall, for example, an insurance carrier in Kentucky proposed what Dr. Zalla calls “half bundling,” where dermatologists would be reimbursed half an office visit service if they were to do another procedure on the same date.

“We held a conference call with AAD representatives and staff with the local Anthem leaders, but they weren’t ready to acknowledge the appropriateness of our concerns. So we brought those concerns to the attention of the national medical director at WellPoint, which oversees Anthem,” Dr. Zalla says. “WellPoint leadership instructed Anthem to follow industry standards and the policy went away.”

Dr. Zalla says he still enjoys practicing and works a full four-day-a-week schedule. He holds posts as associate clinical professor of dermatology at the University of Cincinnati and the University of Louisville, and he enjoys teaching family practice residents who have rotated through his office for the past 40 years.

Today, he practices alongside his son, Mark Zalla, M.D.,also a Mayo-trained dermatologist and skilled Mohs surgeon, and dermatologist Susan Bushelman, M.D.

James A. Zalla, M.D., in January 2011, in a duck blind in the Estero Real Lagoon in northwestern Nicaragua, accessible only by airboat. The lagoon lies in view of the smoldering San Cristobal Volcano, near Chinandega, a quiet agricultural town. (Photo: James A. Zalla, M.D.)

Happy hunting

When Dr. Zalla is not busy in practice, he’s hunting. He has hunted since age 12.

“I enjoy the challenge but only hunt game that will be eaten,” he says. “I’ve hunted in the U.S. and outside the States in Mexico, Honduras, Nicaragua and Argentina, Manitoba, Saskatchewan. In fact, we’re going back to Nicaragua in January for a few days of duck and dove hunting. Our group will also take a supply of used clothing to distribute and take hundreds of used tennis balls to toss to the kids along the back roads. It’s fun to see their excitement at the sight of balls bouncing to them.” DT