Common Medical Billing Errors in Pain Management for 2023

medical billing errors January 26, 2023

Errors in medical billing may be more common than you think. For most patients, mistakes in billing cause frustration, annoyance, and financial problems. Meanwhile, medical billing errors for practices can lead to payment delays and denials, which negatively impact their bottom line.

If we’re going to talk about pain management practices, dealing with “chronic pain” isn’t something ordinary. According to the Centers for Disease Control (CDC), over 50 million people suffer from chronic pain, which equates to 20.4% or one in five adults. It has become a significant public health issue affecting people’s lives and costing society billions of dollars – and medical coding and billing are contributing factors.

Common Medical Billing Errors in Pain Management for 2023

Since over 50 million Americans suffer from chronic pain, there is plenty of room for growth in pain management facilities. That’s a much higher percentage than people suffering from diabetes, heart disease, and cancer. Although there is a lot of growth potential, specific pain management medical billing and coding requirements make it challenging to succeed. 

Coding and billing are only half the battle if you are trying to increase your practice’s revenue. Check out these two common medical billing errors in your pain management practice and develop solutions to make your practice prosper.

1. Failure to Capture Patient Data or Information

Patient registration and scheduling are typically the first steps in medical billing. It is essential to obtain accurate patient information at the beginning so that you can bill claims and collect payment most efficiently. However, if there is lacking information on patient demographics, it might lead to claims being denied. Any problems can arise when patient names, addresses, birth dates, and insurance information need to be corrected or added. 

According to Change Healthcare, their report found that $262 billion of $3 trillion in medical claims were initially denied. In total, $8.5 billion in appeals-related administrative costs were incurred even though 63% of those claims were recoverable.

2. Insufficient Disclosure of Patients’ Financial Responsibilities

Standardizing patient rights across healthcare fields helps patients have uniform expectations and helps standardize care. However, high-deductible plans have led to greater patient responsibility. According to TransUnion Healthcare analysis, most patients likely felt the pinch of higher out-of-pocket costs across all care settings in 2018.

If physicians do not inform their patients in advance of their financial responsibilities, it may cause reimbursement problems. Furthermore, medical practices may need help collecting what they owe.

That’s why all practices should establish proper workflow processes and methods to collect advanced payments from patients with high-deductible health plans. Here are some expert tips to help pain management practices improve collection:

  • Inform patients in advance about the costs of services

You should clearly explain the cost of each service at the time of booking. This will help patients understand what is expected of them.

  • Provide out-of-pocket and insurance education at hand

It’s all about how much insurance they will cover and how much they’ll have to pay for their care.

  • Make it easy for patients to pay

It needs to be more than sending patients a statement and hoping they pay. For your pain management practice to thrive, ensure it tailors patient financial engagement strategies to the demographics it serves. 

3. Billing of Fluoroscopy Can Also Lead to Errors in Pain Management

The most common mistake in pain management billing is charging fluoroscopy separately. Most spinal, endoscopic, and injection procedures involve fluoroscopy for radiological supervision and interpretation. Furthermore, it contains a variety of codes for pain management, such as discography, intra-articular joint procedures, facet block medial branch surgeries, epidural steroid injections, and radiofrequency ablation. In many instances, billing fluoroscopy separately leads to duplicate claims made for the same procedure, resulting in denials that can negatively impact the bottom line.

Remember Modifier 50. The Modifier 50 Bilateral Procedure indicates that bilateral procedures were performed at the same time. Before applying this modifier, a coder should confirm that bilateral is not included in the CPT code’s descriptor. If you plan to inject the sacroiliac joint bilaterally, apply modifier 50.

On the other hand, the non-spinal joints and ligaments such as hips, shoulders, iliolumbar ligament, and troch bursa are reported separately using fluoroscopic guidance codes (77002 for non-spinal).

4. Inability to Specify the Type and Degree of Pain

Pain may be tingling, stabbing, throbbing, dull, or sharp. In addition, it can be acute, chronic, or sudden in onset. Its characteristics can vary from time to time. The nature of pain can be difficult to translate into codes, and the inability to do so may result in errors and discrepancies in documentation and billing.

In this situation, pain management physicians should assess the exact type and severity of the patient’s pain. Pain assessment and documentation are crucial and should be as precise as possible. As a result, coders can choose the appropriate code for the pain and avoid unnecessary complications. 

Codes in ICD-10-CM describe the pain according to its nature.

Refer here for pain management codes 

5. Not Aware of the Updates to Payer Policies and Guidelines

The Centers for Medicare & Medicaid Services (CMS) and other insurance providers constantly update their payer policies. As soon as the updates are released publicly, providers and coders must stay up-to-date with changes in insurance payer policy to ensure maximum reimbursement. If pain management physicians fail to comply, they will suffer.

Often, this requires detective work to piece together information from updates and documentation provided by payers. With medical coding and billing, significant changes typically take effect on January 1 of the following year. However, it is essential to note that information can change throughout the year. 

Tap Into Our Expertise

Despite regular changes in reimbursements, the documentation procedures that pain management physicians used in the past may now result in denials. Documentation requirements are increasing and becoming more specific. The coding staff at your practice must also maintain up-to-date procedures to accommodate each payer’s needs, along with changing policies and codes. However, keeping your revenue cycle moving throughout all the changes can be challenging.

Many pain management practices partner with a professional billing and coding company to resolve issues. At 5 Star 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!

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