Millions of people suffer from some kind of acute or chronic pain every day. Pain can be caused by various things including some kind of disorders, conditions, injuries, or diseases. Almost everyone in the world faces it in one way or another, whether it is for a little while which is known as acute pain or it lasts a little longer period of time or with high intensity known as chronic pain. This raises a concern for healthcare providers and makes pain management medical billing more complicated and expensive.
In this basic guide, we will explore the challenges and basic guidelines that medical practitioners, billers and coders can follow to make their pain management medical billing services efficient.
Challenges in Pain Management Medical Billing
A pain management medical billing company faces several challenges in medical billing and some of the most common challenges are discussed below:
21st Century Cures Act:
The 21st Century Cures Act proposed by the United States Congress in 2016 for the advancements in the field of healthcare poses several challenges for pain management medical billing. A healthcare facility should be compliant with the CA guidelines and regulations. One regulation also necessitates downloading a CA app compliant with the SMART/FHIR capabilities making the whole pain management process complex and challenging.
Prior Authorization:
Several insurance companies urge medical professionals to obtain prior authorization for several pain management solutions like trigger point injections. Insurances only approve pain management claims and resolutions when they are sure that other treatments haven’t succeeded in treating the problem. Some companies also require prior authorization for prescribing pain medication.
Limitations in Medical procedures:
Medical professionals require prior authorization for several procedures and treatments and have to prove if those treatments are required, which slows down this whole process. Healthcare professionals may not be able to perform certain procedures in a limited amount of time which causes delays in the pain management medical billing process resulting in delayed reimbursements.
Guidelines to Make Pain Management Billing Efficient
Thorough Documentation:
You should thoroughly document the complete medical procedure rather than just writing the summaries. According to Medicare guidelines, you can only bill for procedures documented in the medical report which necessitates clear documentation for timely reimbursements.
Accurate Medical Records:
Accurate medical records for patients are important to get timely reimbursements and reduce claim denials and errors. Inaccurate medical records or the use of correction fluid is considered a s fraudulent approach resulting in claim denials and even severe legal actions. Instead of correction fluid, medical practitioners should clearly document and mark the corrections and get them approved by a physician.
Payer Pre-authorization:
Several procedures and treatments in pain management medical billing require prior authorization from the insurance companies. Insurance companies have to make sure if a certain treatment is required or not before they can reimburse for the treatment. Healthcare facilities or practitioners should obtain pre-authorization from the payer for a smooth process and also renew them as necessary.
Stay up-to-date with the payer regulations:
Make sure that you are up-to-date with the payer regulations and policies to reduce claim denials and errors. These payer policies and HIPAA guidelines are updated regularly and you have to be informed of these updates regularly to ensure timely reimbursements.
Coding Expertise:
Healthcare facilities or professionals should choose expert medical billers and coders who are well-versed in pain management medical billing and coding to reduce denials and ensure timely reimbursements. Some facilities also look to outsource pain management medical billing to specialized pain management medical billing companies. This option has proven to be very efficient and cost-effective for several healthcare facilities and professionals as specialized companies have skilled billers and coders which make the probability of errors very less.
By following these basic guidelines, you can ensure efficient pain management medical billing by reducing errors and denials resulting in timely reimbursements.
Conclusion
Pain management is a basic necessity of several people which burdens medical practitioners. Moreover, medical practitioners face several problems while billing for pain management including limitations in medical procedures, prior authorizations and the 21st Century Cure Act which makes it difficult to get timely reimbursements. But thorough documentation, accurate medical records, pre-authorization and outsourcing billing to specialized pain management medical billing companies can be very beneficial for healthcare professionals to reduce denials and errors, streamline revenue cycle management and maximize revenue resulting in practice growth and profitability.