Chronic pain affects around 50 million adults in the US, which are around 1 out of 5 people. Thus, the demand for pain management is highly increasing in the US. And probably why CMS has introduced several codes such as G3002 to reimburse for chronic pain. So, as your healthcare staff stay busy with all these, what should be the option for you in that case? Here, the pain management billing services convert all the pain-relief procedures, such as dry needling, injections and nerve blocks into CPT and ICD codes. So, once the coding is done, the bills are submitted to the insurance companies to get reimbursement. Hence, it helps the clinics to get timely payment and maintain regulations strictly.
Defining Pain Management Billing
Pain management billing is the process to record, code and submit healthcare claims for all the services outsourced expert provides which involve dealing with chronic pian. It includes documentation procedures such as nerve ablation, physical therapies, and epidural injections. The goal is to translate clinical services into CPT, ICD, and HCPCS codes. Apart from that, these RCM experts help to get proper reimbursement from Medicare, Medicaid or private insurers. Hence, it improves the pain management clinic’s financial health.
Defining Chronic Pain Management Billing
The chronic pain management billing process targets all the long-term pain which has been persistent for over 3 months. However, CMS defines chronic pain as “recurrent pain lasting for more than 3 months” and allows clinics to bill regardless of prior diagnosis history, as long as all the documentation process supports these procedures. Hence, these codes are highly essential to get reimbursement for all the pain assessment, crisis planning, and many more.
Common Pain Management Billing Errors
Remember that errors can cost thousands in pain management billing. The common mistakes include using wrong or outdated codes, missing or incorrect modifiers, inadequate documentation, ignoring payer rules, duplicate billing and finally, authorization mistakes. These errors need to be taken care of to streamline the claim submission process and to improve patient satisfaction levels. However, these pain management billing services know how to streamline these errors.
Distinguishing Between Coding and Billing in Pain Management
Accurate billing and coding are linked but serve different tasks. Let's dive into their comparison to understand their functionalities:
Aspect | Billing in Pain Management | Coding in Pain Management |
Definition | Submitting claims and collecting payments for pain-related services. | Select all the CPT codes describing pain treatments like injections. |
Purpose | Ensuring correct reimbursement and cash flow for clinics. | Accurately presenting all the clinical services in data. |
Tasks | Claim submission, payer follow-up, and denial appeals. | Assigning procedure codes, and reviewing documentation. |
Outcome | Paid revenue, claims, and financial reports. | Coded patients encounter all the justifications and records for billing. |
What Are the Specific Pain Management Billing Codes?
Pain management experts use several code sets such as CPT for nerve block and dry needling procedures. HCPCS code for care bundle, ICD code for diagnosis and modifiers which are totally procedure specific. Hence, these codes serve different needs like bundling chronic care codes and diagnostic justification codes. Hence, it makes sure no claim denial occurs.
Categories of Pain Management Codes
According to AMA, pain management codes fall under the CPT coding system. These codes are separated into three categories, category I CPT code which includes 20552, 64483, and 63650. In addition to that, there are also category II CPT codes including G8907 describing pain severity quantified. Finally, the category III CPT codes include 0338T, which is the chemodenervation of paravertebral muscles. Moreover, there are several benefits of hiring pain management services. It helps practitioners to get full reimbursement, reduce claim denials, minimize audit risk, and improve data quality.
CPT Code for Complex Care and Pain Manegement
These codes cover non-face-to-face time spent managing patient health. Furthermore, the codes such as G3002 and G3003 are specifically used for chronic care management. Apart from that, 99490, 99487, and 99489 codes are basically used for complex care management. Finally, the codes such as 64488, 64466, and 64489 are used for abdominal plane blocks.
Excelling with the Help of Pain Management Billing Services
The outsourced experts stay updated with the latest CPT, ICD, and HCPCS codes to make sure no claim denial occurs. Apart from that, they also know all the complex nuances of the HIPAA law to protect patient data. Moreover, these experts also streamline the prior authorization process by verifying patient insurance eligibility, collecting important documents, and then submitting prior authorization requests. It has been observed that the in-house teams come at a high cost because you need to train them and also buy expensive office space for them. On the contrary, the outsourced experts are previously trained, and they don’t require any separate office space. That is one of the main reasons to hire them. Apart from that, these RCM experts also know how to use the clinic’s EHR process to store patient data. Furthermore, they also know the use of the case of electronic prior authorization procedure to submit claims electronically.
There are several pain management options like home remedies, occupational and physical therapy, complementary medicine, and psychological support which the clinic tackles. However, as there are so many companies out there, how can you choose the right expert for your clinic? Before hiring any company, check if they help with patient demographics entry, insurance verification, coding services, claim submission, billing charge entry, claim submission, rejection analysis and AR follow-up. The outsourced experts provide affordable pricing, dedicated assistance, highest productivity standards, and excellent testimonials. These experts can reduce your operational costs by 80% and work with 99.9% accuracy.
These pain management billing services provide 10% buffer resources and customized reports according to the client’s needs. They also give the best infrastructure setup and less than two days of turnaround time in case any issue occurs. In addition to that, these experts provide a dedicated account manager at no extra cost and $1 million insurance coverage in case any issue occurs. These companies also help with other specialties such as DME, gastroenterology, urgent care, cardiology, and many more specialties. So, if you want to streamline your billing process, it can be a good option to hire outsourced experts in that matter.
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