Pain management practices face various challenges, starting from coding to documentation. Always remember that an accurate billing process is important for clinics to get proper reimbursement, but it can also be challenging because of the treatment's complexity. So, outsourcing to the reputable pain management billing companies can be considered as a feasible option to improve your RCM process.
Common Challenges of Pain Management Billing
The healthcare clinics face an enormous number of challenges in pain management. Some of the challenges are described below:
Complexity in Coding
It is regarded as one of the most common issues in pain management. From all the way to nerve blocks, injections, physical therapy, and medication to complex spinal surgeries, all of these treatments require specific ICD and CPT codes. Here, accurate coding is important to make sure the claims don't get denied.
Higher Denials
Another challenge is the high chances of claim denials. The insurers scrutinize all the claims closely, and even if a small error occurs, they can suddenly reject the claim. For example, G89 codes are used to categorize different types of pain, such as acute, chronic, trauma-related, or post-procedural, which becomes difficult for the staff to handle. That's why the insurance companies implemented several processes to scrutinize these claims, where you need to provide substantial evidence to make sure the claim gets approved easily.
Documentation Requirements
Pain management clinics need to provide extensive documentation to support the necessity of the treatment. It includes detailed histories of patients, treatment plans, and evidence of conservative treatment so that no documentation error occurs.
Pre-authorization Requirements
The insurance companies require prior authorization for different pain management treatment. But the issue is that obtaining these authorizations can be highly time-consuming and complicated, mainly for experimental or complex treatments. Now, if the healthcare staff focus on these issues, then they may not get the time to improve patient care.
Regulatory Updates
Healthcare regulations are constantly changing because new diseases are emerging. The pain management clinics need to navigate all the latest regulations, which also include the strict guidelines on opioid prescriptions. For example, the CDC has provided some guidelines that recommend limiting all opioid prescriptions. So, these are the regulatory updates which are needed to be understood to streamline the claim submission process.
Patient's Financial Responsibility
Co-pays and high deductibles are common in the pain management procedure, which sometimes costs thousands of dollars. Hence, it places a huge burden on the patient's shoulders, which makes it difficult for the clinics to collect payments.
How to Optimize Pain Management Billing
Optimizing the billing process is highly important to make sure no claim denial occurs. So, here are some of the processes to optimize the billing process of pain management.
Accurate Coding
Pain management doctors need to use the latest CPT and ICD codes to reduce claim denials. Each year, CMS revises the guidelines for chronic care management. The clinics need to stay updated with the latest billing changes to provide accurate reimbursements. Here, an outsourced pain management billing company brings expertise in CPT, ICD, and HCPCS codes. Apart from that, they also know how to use the HIPAA law properly to protect patient data. Hence, with their help, the healthcare staff can invest their time in patient care.
Proper Documentation
The patient's medical records include detailed procedure notes about the techniques used, injection drugs, and doses. For the pain management treatment, the patient's records contain the anesthesia records, H&P reports, NCD documentation procedure, and local coverage determination. Here, the outsourced experts come who can take care of all these processes to make sure the documentation is accurate.
Staying Updated with the Payer Guidelines
Payers' rules constantly change, which makes it difficult for the healthcare staff to keep up. In addition to that, the healthcare regulations also change, which also becomes a burdensome affair. But as the healthcare staff performs all the healthcare operations, they can't get the time to improve patient care. Here, the pain management billing companies stay updated with the latest regulations, along with the HIPAA law, to make sure no claim denial occurs.
How to Choose the Right Pain Management Billing Company?
Before hiring any company, check if they help with patient demographic entry, insurance verification, coding services, billing charge entry, claim submission, rejection analysis, and AR follow-up. You can also choose the companies that provide affordable pricing, the highest productivity standards, dedicated assistance, and excellent testimonials. These companies can reduce your operational costs by 80% and can also provide 99.9% accuracy. Furthermore, these companies provide a 10% buffer resource and dedicated account managers at no extra cost. They also help with other specialties such as DME, orthotics and prosthetics, urgent care, gastroenterology, cardiology, infusion, and many more specialties. So, if you want to streamline your billing process, you may consider outsourcing to pain management billing companies that can take care of this process.
No comments:
Post a Comment