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Pain Management Articles

How to Optimize Pain Management Coding and Billing 2021 September 9, 2021

Pain Management Code

Change is inevitable in healthcare. Providers are seeking ways to streamline medical billing and coding. Therefore, advanced technology is vital to achieving optimum efficiency in coding and billing processes. 

Pain Management Crisis

Chronic pain is a colossal public health issue. It costs billions of dollars in lost productivity and creates major health problems. According to the Centers for Disease Control (CDC), more than 50 million U.S adults suffer from chronic pain or one in five adults. As incidents of long-term arthritis and age-related conditions go up, this number will continue to rise. There will be more demand for pain medicine in the future. Additionally, payer demands are becoming a hassle. Prior authorization requirements put pain management at risk, affect fee schedules, and require patients to shoulder financial responsibility. 

How to Optimize Coding and Billing in Pain Management Practices

Utilizing the latest technology in revenue cycle management allows your practice to get paid for work in a timely and efficient manner. In pain management, coding and billing solutions are readily available to help your practice. We will explore the latest solutions that help optimize pain management medical billing and coding:

Outsourcing 

Medical practices know that medical billing is a vital but demanding task. Revenue cycle tasks such as patient scheduling, insurance verification, claims management, AR follow-ups, and payment collection can be challenging. When revenue is at stake, the quality of patient care goes down. That’s why many healthcare providers in pain management consider medical billing outsourcing. 

Outsourcing billing and coding allows practices to:

  • Achieve a flexible schedule for staff.
  • Maintain continuity and manage risks.
  • Boost growth.
  • Manage the basic tasks efficiently.
  • Ensure operational control.
  • Make sure reimbursements are prompt.
  • Reduce expenditures.
  • Increase productivity.
  • Cut revenue leaks.
  • Balance AR (account receivables)

Outsourcing is an effective way for medical practices to grow and expand while minimizing costs. Indeed, the best pain management billing company will help you ensure profitable revenue.

Automation of coding and billing

Automation is the future of medical billing and coding. Software automation can assist healthcare providers in cutting down unnecessary expenditures. Furthermore, it eliminates time-consuming tasks.. Billing automation can also bring considerable benefits to insurance pre-authorization. Moreover, the process of verifying eligibility and payment limits is simplified.. Thus, patients can get immediate care as soon as they need it.

Accurate pain management coding

Pain management coding always must be accurate. It’s the first step towards optimizing your healthcare revenue cycle management. A correct coding initiative is essential from a compliance standpoint. It is also helpful for reducing rejections, claim denials and ensures optimum reimbursements. Claims must be error-free and precise before they are sent out.

Here are coding initiatives that will increase collection and reduce denials:

  • Hire coding specialists for accuracy and efficiency. Partnering with a certified medical coder that focuses on pain management practices can quickly improve your cash flow.
  • Avoid non-specific diagnoses codes. In comparison with ICD 9, ICD 10 documentation requirements are much more detailed.
  • Avoid incorrect modifier usage.Make sure your coding follows payer-specific guidelines so that you don’t face denials or underpayments.
  • Avoid using a higher-paying code on a claim to receive big reimbursements. This refers to upcoding. This issue can cause more claim denials.
  • Stop upcoding and unbundling, as both are  illegal. Unbundling involves submitting bills piecemeal to maximize the reimbursement for tests and procedures that require billing together.
  • The process of Prior Authorization is necessary.
  • Stay away from under-coding – omitting or exchanging codes for a lower level of codes or less expensive code is leaving money on the table.
  • The medical necessity needs more documentation.

Switching to Telehealth 

The concept of a virtual visit is an interaction between patient and provider that doesn’t take place in the same room. It is also becoming more common in health care. For medical practitioners, virtual visits affect medical billing. The new CPT codes reflected the billing and procedures changes, so insurers had to update their policies right away. COVID-19 prompted many new treatments and protocols, which resulted in modifications to coding and billing. Health care providers lost a lot of money in the transition period due to denied claims. That’s why pain management billing software for your practice helps incorporate these changes. In addition, it prevents revenue leaks and ensures maximum future compatibility. 

New Software for Revenue Cycle Management (RCM)

What is Revenue Cycle Management software? It helps physicians and healthcare providers track and manage revenue from a patient’s lifecycle. Revenue cycle management solutions augment medical billing software functionality. It includes:

Seamless integration with EHR/EMR software – an easier way for exchanging data with the billing system.

Insurance eligibility and pre-authorization tools ensure the revenue collection process starts on the right path.

Advanced A/R management enables you to assist your facility’s staff and patients with the payment process.

Clearinghousean in-house intermediary service reduces  the time spent on the remittance process.

More important than ever, these features support financial operations throughout the life cycle of a medical facility.

Tap Into Our Expertise

It’s crucial to rely on current medical coding and billing solutions in light of these changes. These processes can further enhance your— billing processes, revenue cycle, and pain management practice.

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!


Pain Management: Signs You Need to Outsource Your Billing and Coding September 9, 2021

Medical billing and coding

Medical billing and coding are a great challenge for healthcare providers. Veteran surgeons and seasoned healthcare professionals see it as a struggle.  Regardless of the resources and assets, hindrances still occur.  It’s a parade of medical codes, insufficient time, and failure to follow-up for collections. How do you make more time for your patients? 

Medical practices are now finding ways to find the appropriate solution. In particular, pain management practices continue to deal with complex billing and coding. If your pain management practice seems to face many issues, you can always ask for our assistance. At 5 Star Billing Services, we offer comprehensive pain management billing services and collections. We can help your pain management practice grow.  So what are the signs that you need to outsource your billing and coding?

Late Payments

Following up on payments causes frustration. The increased reliance on patient payments requires an increased collection budget. Hiring a pain management billing service makes billing collections and claims easier. Our pain management billing experts track late payments quicker, so the in-house staff can focus on other tasks. About 54% of insured patients have trouble understanding their medical bills. We can also help patients clarify their confusion with their claims and other processes. 

The Decline of Patient Care

Spending more time on billing and coding than patient care is a big problem. Medical exams may get delayed when your nurses are busy with billing processes. In the end, your patients may end up walking out and never return to your practice.  Your staff is probably finding it hard juggling multiple tasks. That’s why outsourcing your billing and coding is the best option. Our pain management billing experts are always available to handle all the complex billing tasks on your behalf.

Pressure on staff

The administrative staff also faces difficulties with in-house medical billing. It’s time-consuming and frustrating. Training is necessary for up-to-date changes in rules and codes. However, it also takes significant time away from dealing with other admin tasks. In that case, you may need to assign tasks to other departments. Many practices are still hesitant to outsource their billing and coding. They fear that the cost will be prohibitive, but you can save a lot of money by outsourcing medical billing. It will help your practice become more efficient and help your staff maintain a work-life balance.

Loss of Workforce

High staff turnover is always a problem. When a staff member leaves, the remaining work might get divided among your team members. Often, these members lack medical billing and coding expertise, and new hires may leave before they complete their training. These issues reduce revenues, increase billing and coding errors, and erodes the quality of care. That’s why healthcare providers want the best for their pain management practices. Your patients can benefit from the services, and your pain management practice will be stable. In contrast, if staff resignations are piling up, it may be time to look for pain management billing services. Let the experts handle the tough job.

Struggle to find Staff Replacement

Finding qualified staff for your pain management practice can be hard. Both urban and rural areas are experiencing a shortage of skilled workers. Coding experts, medical billers, and administrative staff are especially hard to find. Other physician offices have high turnover rates due to problems with managers or office politics. According to the Medical Group Management Association (MGMA), practice costs have risen by 50%. 

Increase in Insurance Denials

To maintain compliance with insurance coverage requirements, AR and billing staff must continually handle insurance denials. A high rate of insurance denials could indicate a poor denial resolution process. Experts can help you expedite your transactions. Our AR management and electronic claims in pain management reduce delays. Also, we provide an initial evaluation of your practice before we move forward. 

Account Receivables are Too High

In a short time, account receivables (AR) can mount up. That might be because of faulty software or an inexperienced biller. You may need to restructure your entire patient-to-pay revenue cycle. Likewise, you may not have enough staff to handle claims errors and denials right away. AR levels can rapidly rise due to any of these reasons or a combination of them. The American Medical Association (AMA) stated that the average is now 24%, with half of that percentage collected at the point-of-service—thereby adding to the overall A/R increase. Further, an unclear collections success rate results in administrative waste, unnecessary write-offs, and a loss of bottom-line profit.

Tap Into Our Expertise

Pain management coding and billing are indeed strenuous. That is why we provide you with several reasons to consider medical outsourcing. With the help of an outsourcing billing company, your pain management practice will grow.

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!


Billing & Revenue Cycle Problems in Pain Management July 30, 2021

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.

  1. 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.

  1. 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.

  1. 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.

  1. 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!


Tips to Improve Profitability in Pain Management Practices March 31, 2021

Pain management is a specialty in flux. Not only are more chronic pain sufferers seeking out treatment, but the release of a recent Center for Disease Control report, which found more people die from prescription drug overdoses than heroin and cocaine combined, has created a backlash over opioid prescriptions and a call for alternative treatments. Here are 8 tips for a pain management center to increase profitability:

Increase Patient Referrals

Increasing the number of patients in a pain management practice is the first step toward increased profitability. Most patients are referred to a pain management practice by a primary care provider, so increasing referrals by primary care providers is one way to raise the patient volume. To generate more patients, you need to take a look at your clinical model and your relationship with multiple primary care providers. Conduct assessments and provide changes to your given services to create a unique story that will encourage referring physicians to frequently send their patients to you with a pain condition.  

Hire a physician liaison. 

 A physician liaison plays an important role in managing and building relationships with primary care providers for your practice. Someone must actively inform and interact with primary care doctors that the services they need are available in your practice. They can potentially get you 50-75 new referrals each month. A four-year degree in an allied health area such as functional or behavioral health is required for this role. They should have a friendly demeanor and be at ease approaching and engaging with people. 

Communicate with primary care providers

To ensure a consistent and continued patient referral flow, maintaining constant communication with primary care doctors is crucial. It includes providing timely reports and reminders to prescribing doctors, primary providers, and specialists. Associations with prescribing doctors are viewed as collaborations. They are familiar with their patients’ histories and needs, while pain management practices have insight, support, and service in an environment where many primary care doctors lack knowledge and experience.

Offer cutting-edge treatments. 

Primary care providers would refer more patients to you if you offer all pain management procedures like radiofrequency ablation and spinal cord stimulator implants. According to the co-founder of Universal Pain Management, Francis Riegler, MD, the spinal cord stimulator devices are only available to only three medical device manufacturers and the market is extremely competitive. Practices should inquire with other vendors around their vicinity to get the best price. 

Incorporate anesthesia.

Incorporating anesthesia into your procedures can increase your revenue than with conscious sedation or no sedation. However, it should always be done with medical necessity. Base it on a patient-by-patient case and adhere to the strict protocols on regulatory requirements. 

Maximize the use of space. 

Use every inch of space of your practice wisely. You can convert your large conference room into two additional procedure rooms. You can also transfer your follow-up consultations to telehealth, too. 

Automate tasks

You can set up an automated system for your scheduling, inquiries, refill requests, and more. You’d be able to reduce no-shows too with patient portals and patient apps where your patients can schedule or cancel their appointments 24/7. A patient self-service check-in kiosk will lessen the administrative burden of your staff by expediting the check-in processes. 

Always Double-check

Having complete and correct patient information and correct coding are critical to profitability. Train your staff to always double-check all data to ensure proper reimbursement. Also, take time to evaluate contracts with payors to make sure the practice received the agreed-upon reimbursement for procedures and treatments. 

Tap Into Our Expertise

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times.

Schedule a consultation with our experts today!


Measuring Pain Practice Accounts Receivable For Better Billing Performance March 19, 2021

pain practice accounts

How to Measure Accounts Receivable

You can use the following methods in measuring the quality of the accounts receivables of your Pain Management Practice:

1. Day’s Sales Outstanding (DSO)

The day’s sales outstanding (DSO) ratio is a simple way to assess the quality of accounts receivables. It’s determined by dividing average accounts receivables by revenue and multiplying by 365. The DSO ratio indicates how long it takes practice to turn its receivables into cash on average. It is often easier to use than the accounts receivable-to-sales ratio and the accounts receivable turnover ratio because it is in an intuitive unit of calculation (days).

2. Accounts Receivable Turnover Ratio

Analyzing a practice’s accounts receivables turnover ratio is another way to assess the quality of its receivables. It’s calculated by dividing a period’s sales by the average accounts receivables balance during that period.

The accounts receivable turnover ratio is a metric that measures how quickly a company can convert its receivables into cash. A high ratio usually indicates that a practice’s accounts receivables are of higher quality, as it reveals that receivables are being converted to cash more quickly.

Because a company can receive cash from its accounts receivables faster, a shorter DSO indicates that the accounts receivables quality is higher. While a high DSO ratio (more than 90 days) can indicate that receivables will become “stale” and may not be collected, it also indicates the poor quality of practice earnings.

3. Accounts Receivable-to-Sales Ratio

The accounts receivable-to-sales ratio is a simple way to assess the quality of your receivables. The ratio is calculated by dividing accounts receivable at a given point in time by sales over time. It shows what percentage of a practice’s sales are still owed to them. With a few tweaks, it’s the inverse of the accounts receivable turnover ratio. It’s the exact opposite of the accounts receivable turnover ratio, but with a few tweaks.

Since it is not guaranteed that all accounts receivable can be collected, a high accounts receivable-to-sales ratio may indicate a riskier practice with a poor quality of accounts receivable.

What Period Should be Analyzed for the Formulas?

While opinions differ on this, we think it is prudent to use a period that is appropriate for your specialty and practice and then study this measure over time to determine its pattern for your work. We suggest a time limit of the last 90 days. Divide your  Current A/R Balance with the quotient of Total Billed Charges over the past 90 days. 

How to Determine if the Result is Good or Bad?

The lower the A/R Days, the better it is. This means you’ll have fewer billed payments awaiting billing and adjudication. The A/R Days benchmark varies by specialty and can be influenced by practice-specific factors like treatment mix, payer mix, and internal policies. Consider the following scenarios:

Insurance providers can take longer to assess and pay claims for a specialty practice that conducts complex procedures with high average payout rates, such as Interventional Pain, resulting in a longer average period to adjudicate and pay the practice’s claims and a higher A/R Days measure.

Since pain practices are subject to denials due to inadequate prior authorization, medical necessity, or other obstacles, these factors cause claims adjudication delays, resulting in higher average A/R Days. Pain practices need to be aggressive about collecting time-of-service payments from patients at the front desk because these balances can take time to collect which can cause A/R Days to rise.

What other Factors Need to be Considered in Evaluating A/R Days?

The A/R balance of practice often includes both debit and credit balances, which means that although the majority of the balances are debited to be paid to the practice, others are credits showing possible overpayments that may be refunded. Significant credit balances in the total A/R balance will outweigh large debit balances, resulting in a deceptive A/R Days metric. Specialty practices that have higher than average credit balances can take this into account when calculating A/R Days. The argument is that when determining whether your A/R day’s number is positive or bad, you must understand the content and essence of the statements that make up your A/R Balances.

Tap Into Our Expertise

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times.

Schedule a consultation with our experts today!


Three Questions to Ask Your Pain Management & Surgery Center Billing Service Provider October 11, 2013

surgery center billing services

Making the decision to outsource your pain management billing to a third-party can be difficult, especially when it comes to choosing the right company that can meet the needs of your practice. After all, the performance of the billing company and their overall ability to handle your revenue cycle processes will determine your practice’s financial health.

Before making a final decision about outsourcing, it is important that you ask each potential medical billing partner the following questions. Getting answers will help ensure that the agency you ultimately choose to work with has your practice’s best interests in mind.

1. Will we have access to our data?

Whether your pain management practice chooses to outsource a few medical billing processes or every aspect of billing and collections, it is important for the third-party agency to be transparent and to share critical information with you whenever you need it. Professional pain management billing services will provide access to their system for monitoring and keep records of communications with patients, for example, so that you can monitor quality assurance at all times. Check with your outsourcing partner to see what they provide.

2. Will you provide detailed monthly reports?

Outsourcing pain management billing can help your practice be more hands-off and devote more time to patients. However, you still want to know how your practice’s finances are. Make sure your billing company provides regular reports about your accounts receivables, including how much they’ve collected and how much is still owed. These reports will help you determine how effective the billing company’s efforts are and which areas need improvement.

3. What kinds of fees or service charges will we incur?

billing services for surgery centersFee structures can vary from one pain management billing service to another; however, most third-party agencies will either request:

  1. a percentage of the total amount that they collect
  2. a flat fee per claim

Agencies that choose to charge a flat rate may also offer other accounting and administrative services that can be of real benefit to your practice. The fee structure that provides the greatest financial benefit to your pain management organization will depend on the amount of money you expect to collect each month. Be sure to review the terms of your contract carefully and ask questions if you don’t understand how something works.

5 Star Billing Services, Inc. has provided professional medical billing, collection and administrative services for pain management practices for many years. Contact us today to start reducing denials, decreasing costs, and improving cash flow.


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