Billing & Revenue Cycle Problems in Pain Management

Maintaining a profitable practice means ensuring a healthy revenue cycle for any pain management practice. However, pain management practices still encounter hardships due to their complexities in billing and coding. It can be challenging to manage the processes when it involves stakeholders and obtaining payment relies on consistent interactions. Keeping departmental and payer communications open can help keep accurate information sorted and categorized throughout the process. The following are the most common billing and revenue cycle issues in Pain Management Practices:

1. A manual process on claims denial management

• Using a manual process for managing denials can slow down your cash flow. At the same time, it can still lead to more inaccuracies and errors.
• According to Michelle Tohill, Director of Revenue Cycle Management at Bonafide Management System, healthcare providers should switch to automated systems to avoid denials. In addition, staying on top of diagnostic codes and different insurance policies can be exhausting. However, many software providers will automatically update requirements and coding procedures.
• She also added that there are still many software providers who are constantly updating codes and requirements. In this way, your billing staff can double-check claims. Making sure they meet the demands and saving research time.
• Furthermore, your staff needs to be aware of future happenings to get reimbursements, less time figuring things out, and detect necessary parties.
• Automating claim denial management in medical billing can help providers identify errors before submitting claims.
• There may still be difficulties toward submitting claims and associated labors in managing denials, stated Brendan FitzGerald, HIMSS Analytics Director of Research. Surprisingly, software providers have not automated the denial management process through a vendor-provided solution.
• If managing denials are a lot, productivity might be slow through a manual process.
• Denial management is still a question, whether it is outsourcing or in-house. The HIMSS study found that 44% of healthcare professionals preferred outsourcing such as revenue cycle management, clearinghouses, or EHRs, while 18% implemented an automated system in-house.
• Medical billing teams from denial management draw data over healthcare industries and handle multiple payer rules and codes.

2. Coding Errors

Incorrect codes will lead to deferred, denied, or half-paid claims. Pain management practices continue to struggle with the complexities of codes for pain management coding procedures. These are the top coding issues:

• Inaccurate coding on clinical coverage
• Improper procedural codes
• Out-of-date codes

These can bring about mistakes that become costly to your pain management practice. On the other hand, money is not always an issue. It can also lead to legal consequences like:

• Imprisonment – for penalties and false claims submitted per file
• Clinical Maltreatment – If there’s proof of deliberate distortion throughout quite a while and across countless patients. 

 Even though these may seem alarming, the most well-known result of billing issues is that insurance agencies will not reimburse your cases.

3. Prior Authorization Delays

Prior Authorization (PA) setbacks can deprive physicians of time in catering to patients and increase their expenditures. Some medical insurance companies require prior authorizations (PA) before providing pain management procedures. It serves as a significant barrier for physicians to deliver quality care. PA helps with:

• Monitoring healthcare costs
• Proper approval from patients plan
• Providing payers with a secure prescription for medicine and drugs

Despite this, the process can slow down the delivery of needed services and care for patients. To improve PA performance, physicians adopt the usage of Pain Management EMR Software. Electronic Prior Authorization integrates directly with your electronic medical records (EMRs). Healthcare professionals can use it to obtain prior authorization in real-time. Additionally, it eliminates the need for time-consuming paper forms, faxes, and telephone calls.

4. No proper staff training

Unskilled staff in the healthcare industry might cause revenue cycle management issues. In relation, they might not bill or capture patient data correctly. Proper staff training is necessary to capture patient’s demographic information on the front end. Also, on how to translate that data to successful insurance claims after that. With that, patient schedules and registrations must also be accurate to avoid problems in revenue. Conducting staff training might be time-consuming, but it is worthwhile. It can increase cash flow well after, although it might also be costly. Moreover, your pain management practice will boost these areas:

• Enhance job proficiency
• Boost staff self-esteem
• Employees will stay longer to your business

If you also think of outsourcing your revenue cycle management, talk to a Pain Management Billing specialist. Working with them can save you time and resources.

5. Failure to follow up on Accounts Receivable (A/R)

A/R follow-up process can be a handful at most times. The team assigned for this is to consistently handle interactions with patients, healthcare providers, and insurance agencies. There are also processes that your team needs to complete:

• Verification,
• Charge entry
• Payment posting

Medical billing specialists regulate the precise diagnosis and exact procedure codes based on the treatment plan. If your A/R team has issues regarding this, your practice might be at stake. Your practice cannot establish good revenue without a proper A/R process. Without it, it can lead to high collections of A/R, and backlogs will occur. The worse thing is that insurance companies will deny claims if your A/R team fails these processes. If you want to increase your profitability, you can read these 8 Tips in Pain Management Practice.

Tap Into Our Expertise

These are just some of the common problems associated with pain management practices. Think about outsourcing your revenue cycle management to trained and experienced medical billers and coders. Having people take charge of your medical practice problems and provide solutions is always a great idea to boost revenue.

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

Schedule a call with our experts today!