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How to Optimize Pain Management Coding and Billing 2021

Pain Management Code September 9, 2021

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!


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