Top 5 Issues in Pain Management Billing and Their Solutions

It has been observed that more than 60% of clinics suffer from pain management billing issues. Do you know why these clinics face such challenges? It's because there is a dearth of specialists who can create an accurate billing process. That's where you need a specialist pain management billing company that can streamline your business process. These specialists get rigorous training to get updated with the changing healthcare regulations. Apart from that, they also know all the intricate details of the PA, AR process and also other specialties. Moreover, they are highly cost-effective compared to the in-house team. Furthermore, they also stay updated with the latest technologies and tools. But you all know these outsourced experts solve these issues, right? Then what are the other issues they solve? Let's get to the answer, then.  

Major Issues in Pain Management Billing  

You need to make sure your RCM process includes an accurate coding and billing process. So, let's dive into the five errors in pain management billing.   

Inappropriate Documentation  

Accurate and complete documentation portrays an essential role in the claim submission process. It has been observed that claim denial occurs due to missing information on various issues. That's why providers need to incorporate thorough and accurate treatment information in the addendum. On the other hand, the outsourced RCM companies make sure the documentation process is thorough and accurate. These experts have been creating an accurate documentation process to make sure no claim denial occurs.  

Not Staying Current with the Latest Changes in Payer Policies  

Do you know why insurance claims get denied? It’s because they don’t stay updated with payer policies. It helps the hospitals to get the maximum reimbursement. But the issue is that there are so many insurance payers. So, your healthcare staff have to go through all the payer policy updates, for which they don't have the time. That's where the pain management billing experts arrive. The payers always announce their policy change in the first quarter of every year. But the information can change throughout the year. But when you hire an outsourced RCM company, you don't have to think about this process. They can take care of this process.  

Billing Different Process Separately  

It has been observed that many pain management clinics bill the fluoroscopy, non-imaging procedures and surgical process separately. You need to be sure that a bundled procedure is used, such as 27096 for SI joint, and also others for facet injections or medical branch blocks. Moreover, there are separate fluoro guidance codes for peripheral joints, which many providers don't even know of. On the contrary, the outsourced pain management billing company knows all the complex processes to bill the fluoroscopy separately. Apart from that, they also streamline the PA process. These experts first verify patient insurance eligibility, collect important documents, and then streamline the PA process to make sure no claim denial occurs.  

Using Modifiers in Pain Management  

Modifiers are used to clarify the services provided. Moreover, it can also cause claim denials if not used correctly. There are several modifiers, such as:   

• LT, which is anatomically left  

• RT, it is anatomically right  

• 50 is bilateral  

• 59 is the independent service or procedure  

• 52 and 53 are the incomplete procedures  

The healthcare staff need to focus on patient care, that’s why they can’t give time on incorporating new regulations. That's why they hire an outsourced pain management billing company that learn about all these complex modifiers. Apart from that, these experts also know the latest changes in the CPT, ICD, and HCPCS codes.  

Exceeding Limits on Approved Procedures  

Pain medicine requires insight into the number of procedures performed compared to the allowed approved visits. Always remember that exceeding the approved visits is very common. That's where the outsourced experts come in. These experts are trained rigorously using the latest healthcare regulations. Apart from that, they also know how to work with the right technology to quicken the claim submission process. Furthermore, they also know how to use the electronic prior authorization process to streamline the claim submission process.  

How to Choose the Right Company? 

There are several options for pain management. These options include home remedies, occupational and physical therapy, and many more. So, before you choose a pain management RCM company, check if they help with entering patient demographics, eligibility checking, coding services, billing charge entry, claims submission, and rejection analysis. Apart from that, these outsourced companies also provide affordable pricing, the highest productivity standards, dedicated assistance, and excellent testimonials. These outsourced experts can reduce your operational costs by 80%. They also operate with 99.9% accuracy in claim submission. They provide dedicated account managers at no extra cost. Finally, they also don't have any binding contracts or restrictive clauses. So, if you want to streamline the billing process, you may consider outsourcing to pain management billing companies.