Pain management medical billing is complicated because doctors must perform various procedures in pain management clinics. Therefore, when pain management practices are compared to other medical specialties, they face several unique challenges. As a result of recent changes to payer payment policies and coding standards, billing for pain management services has become more crucial.
Here are some issues with reimbursement that pain management practices have to deal with, along with some ideas for increasing profits.
Major problems associated with pain management medical billing:
Failure to Maintain Relevant Payer Policies and Procedures
Many pain management practices do not adhere to relevant payer policies and procedures, which leads to numerous coding errors. As a result, these errors have an adverse effect on pain management medical billing. To secure optimum reimbursement, providers and coders must keep up with changes in insurance payer policies. As a result, for smooth billing for pain management services, a significant amount of time and effort is required to obtain the necessary information from various insurance companies.
Not Providing the Required Documentation for the Visit
Accurate and thorough documentation is more important than ever in the pain management medical billing field because denials are frequently made due to missing data on various issues. The original operating note or an update must contain the provider’s complete and correct treatment information. Therefore, it is the responsibility of the billing department to decipher and code the notices as soon as they are received.
No Proper Knowledge of Billing for fluoroscopy:
Many medical facilities offer pain management services and separately bill for fluoroscopy. They verify whether the operation includes any bundled charges, such as SI Joint (27096), medial branch books, or facet injections. Additionally, it would help if you individually recognized the fluoro guidance codes for peripheral joints. A good management manual in the form of a book might be beneficial.
In light of these challenges, it is tough for pain treatment practices to expand their clientele and maintain their financial viability. The following actions can be helpful:
Recognize payer guidelines and new codes:
The newest ICD-10 and CPT codes must be used when submitting correct claims, and pain management practitioners must know payer policies. Both new pain management codes and code replacements are included in CPT 2017.
Communicate with your primary care physician.
Maintaining a continual connection with primary care physicians guarantees a steady and ongoing patient referral flow. It involves giving prescribing physicians, primary care providers, and specialists timely updates and reminders.
Understand and control the expenses of processes performed:
According to the research in Beckers’ ASC Review, pain management institutions should know how to control the expenses associated with treatments like epidurals and sophisticated procedures like radiofrequency ablation (RFA). They can assess whether or not the reimbursements are sufficient by examining the prices of the best procedures.
Make use of cutting-edge treatments.
Primary care doctors will send more patients to you if you perform all the pain treatment procedures, such as spinal cord stimulator implants and radiofrequency ablation. Francis Riegler, MD, a co-founder of Universal Pain Management, claims that the market for spinal cord stimulator devices is very competitive and that only three medical device makers have access to them. In order to get the best deal, practices should contact local vendors.
Learn better contract negotiation techniques:
Pain specialists can better negotiate contracts with payers once they know the expenses associated with their various therapies. Understanding the market, the complexity of the pain treatment industry, and financial analytics are all necessary skills for contract negotiations.
In this complicated situation, pain doctors should work with an experienced medical coding company like Medcare MSO that has certified medical coders on board.
Our billing team members are well-versed in all medical terms and how a doctor performs the procedure. We can help ensure accurate documentation and comprehend payer expectations since we know what to include in the operational note and how to assign the proper codes. Additionally, we provide comprehensive diagnostic billing analysis to assist physicians in improving the financial performance of their practices and making necessary changes. To get more information you may visit our website or contact us.