Honestly, managing a clinic and the other tasks like billing and coding that come with it is challenging. You try to stay compliant, especially when it comes to pain management billing. There are a few unique challenges when it comes to pain management billing. The reason for its complexity is that it has difficult codes and constant updates in coding. Here are a few common billing errors that can save your time and money.
Let’s discuss 5 pain management billing mistakes and how you can avoid them.
Using incorrect modifiers
One of the most common errors you might run into while working on coding is the misuse or omission of modifiers. Modifiers are two-digit codes added to CPT codes that help explain the service you provided more clearly. In this case, modifiers like -25 (for a significant, separately identifiable evaluation and management service) and -59 (for a distinct procedural service) come up often.
They are frequently applied the wrong way. For instance, if you use modifier -25 but don’t have clearly documented proof of a separate E/M service, it could get your claim denied. On the flip side, using modifier -59 when it doesn’t truly apply may be seen as unbundling something payers watch closely.
Solution: Always make sure your documentation backs up every modifier you use. If coding isn’t your strong suit, working with a specialized billing company can really help you stay on track and avoid costly mistakes.
Not staying updated with the CPT and ICD-10 code changes
Medical coding for pain management undergoes annual revisions, and if you fail to use the most current CPT or ICD-10 codes, it can hamper your reimbursement rates. You should not submit claims with outdated or incorrect codes. If you do so, it will increase the chances of denials, creating unnecessary delays for your practice.
Take procedures like genicular nerve blocks or radiofrequency ablation; new codes have been added for these in recent years. If you haven’t updated your coding practices, payers might not even process your claims or worse, they could reject them outright.
Solution: You should make it a habit to check CMS updates regularly. And if keeping up with all the coding changes feels too much, you might want to consider outsourcing pain management billing to a company that stays up to date so you don’t have to.
Lack of medically necessary documents
Have you ever thought about what is the main reason for claim denials? Insurers often deny claims if they think a procedure wasn’t medically necessary even if you know it was. Treatments like epidural injections, nerve blocks, or spinal cord stimulators need to be backed by proper clinical documentation to get approved.
Another common mistake is not fully documenting the patient’s pain history, previous failed treatments, or the specific medical reason for choosing a particular procedure. If you don’t clearly explain the “why” behind the treatment, payers are much more likely to question or deny the claim.
Solution: You should include SOPs on the diagnosis, the patient’s symptoms, and why the other options didn’t work. The stronger your documentation, the better your chances of getting paid. You might be struggling with the billing necessities as well. In such scenarios, you can go for professional billing services.
Concluding
These errors in billing can create a lot of trouble when it comes to your practice’s revenue. Billing errors and coding errors can be one of the biggest reasons for claim denials. As a pain management clinic, you should go for professional billing services to avoid any such reimbursement or payment issues. Therefore, you can consider outsourcing billing to an expert.
No comments:
Post a Comment