Three Billing Challenges for Pain Management

Getting paid for pain management procedures can be a frustrating, sometimes overwhelming process that can take as much as six months thanks to ever-changing restrictions and regulations. Sometimes a claim can be denied because payers deem it “not medically necessary” or “experimental” in nature. Of course, the opioid epidemic brought with it more concerns about overprescribing pain medications and resulted in more scrutiny than ever for pain specialists. In all, reimbursement for pain management is drastically different than what it used to be. All the while, chronic pain affects more U.S. citizens than the combined total of cancer, diabetes and heart disease. What’s the trick to getting paid? Your patient population, your costs and your billing expert.

  1. Simply put, Medicare and Medicaid are the most restrictive payers when it comes to pain. Building a patient population that leans heavier on the side of commercial payers is important to a healthy revenue cycle. However, that’s a lot easier said than done. Medicare beneficiaries continue to show a more significant use of interventional pain management techniques when compared to patients with private insurance. In other words, the pool of patients needing chronic pain management is has more Medicare beneficiaries than those privately insured. This means you will still need to include these patients in your practice to grow. Having a strong, local referral source can help you grow the patients you are looking for.
  2. Understanding your practice’s revenue cycle management is important. Clearly, knowing the cost of certain procedures that your office performs is essential to understanding the profit your practice can earn. Equally important is understanding the what procedures are getting denied by what payers. Utilizing the most accepted, cost-effective methods for pain management should be a goal of any pain specialists. It’s not always that easy, though. New technology and treatment options arrive on the scene regularly and require constant attention. It can be intense and rather time consuming to stay on top of costs but, nevertheless, critical to the overall health of your practice.
  3. Coding is a never-ending battle for pain management specialists. Having an expert that understands the payer requirements is only half the key. Finding the right combination of anatomic knowledge, payer requirements and medical terminology is absolutely necessary. Providers aren’t always specific in their operative notes. The coder needs to be able to glean the right information in order to assign the appropriate billing codes. For some practices, outsourcing your billing will make the most sense. This will save you time and most often help you get reimbursed faster, with fewer denials.

With the right patient population, an understanding of costs and reimbursements, in addition to a well-educated and expert billing specialist, you can overcome many of the daily headaches and obstacles that pain management specialists face on a daily basis.

Comments 14

  1. There is a medicare approved procedure for chronic pain diagnosis which is more effective and far more accurate than EMG or NCV…and reduces the need for MRI by 50%. Medicare reimburses for the procedure which costs less than an MRI and further reduces opioid script.
    This procedure targets, and documents the EXACT nerve causing the pain so the physician can treat the pain far more effectively and improve patient outcomes by an astonishing 170%.
    The procedure is endorsed by the AASEM which also board-certifies the doctors in this procedure (spf-ncs)
    there are now nearly 3,000 doctors in America performing this procedure.

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