According to the American Academy of Pain Medicine, millions of people within the United States suffer from either acute or chronic pain, and pain has become a public health problem that costs society billions of dollars each year. With so many people affected by pain, there’s significant room for pain management practices to grow their businesses. However, over the past few years, new state and federal regulations have brought about some unique challenges that affect pain management practices. Payer reimbursement policies and coding changes have made it more challenging for pain management billing practices to increase revenue. However, once you understand some of the challenges facing your practice, there are strategies your practice can implement to begin improving revenue despite these challenges.
New Challenges Facing Pain Management Practices
Becker’s ASC Review published a special report on some of the challenges that pain management practices are now facing after the implementation of ICD-10. Just a few of the challenges that practices are now facing include:
Challenge #1 – Prior Authorization
Many payers now require physicians to get prior authorizations before providing certain pain management treatments, and approvals are only given if there’s medical necessity or proof that more conservative treatments haven’t worked. This includes the need for prior authorization on many pain medications.
Challenge #2 – Limits on Procedures
Physicians are often limited on the number of times they’re able to perform certain procedures.
Challenge #3 – Post-Service Prepayment Coding Reviews
Post-service prepayment coding reviews may take place, holding up payments for as long as 180 days if claims have been flagged for further review. This makes it difficult to keep the revenue cycle moving.
Challenge #4 – More Controls on Prescribing Certain Drug Combinations
When it comes to prescribing certain complex medications or combinations of drugs, physicians have to submit proof that this treatment is needed and that this combination is proven to be suitable for the patient.
Challenge #5 – Some Therapies aren’t Reimbursed
Certain alternative non-pharmacologic treatments, which are recommended by the CDC and other organizations to treat pain may not be reimbursed by some payers.
Challenge #6 – Payers are also Overwhelmed
The huge number of pain management claims and the time needed to review them to ensure they’re meeting new guidelines is also overwhelming for payers. In some cases, payers are having beneficiary advisory companies deal with their approvals.
Challenge #7 – Growing Pain Medication Dependency Epidemic
There’s a growing epidemic in the country of patients becoming dependent on pain medications. to fight this epidemic, payers and other organizations are trying to reduce the problem, which results in some physicians being a target for overprescribing these types of medications.
Strategies for Improving Revenue Despite the Challenges
These new challenges make it tough for pain management practices to grow and increase revenue. Begin implementing the following strategies to improve revenue despite these challenges.
Strategy #1 – Understand New Codes and Rules
First, it’s important to make sure that your staff, including front desk staff and physicians, understand the new payer rules and new codes. Staff members must be up-to-date on the latest CPT and ICD-10 codes since there have been several new CPT code revisions, some deletions, and the addition of new pain management codes. Coding mistakes are one of the biggest reasons that pain management practices deal with denials, so make sure all staff members are current on the latest codes and rules.
Strategy #2 – Cater to a Varied Patient Population
Although you want to make sure you’re catering to Medicaid and Medicare populations at your pain management practice, catering to varied patient populations can help you grow your practice. This means beginning to grow your practice to accept patients who have workers’ comp insurance and commercial insurance. Many pain procedures have the ability to bring in a significant amount of revenue to your practice, and if you have a varied patient population, it helps your practice stay competitive while fueling growth and increased revenue.
Strategy #3 – Better Understand the Cost of Complex Procedures
Your pain management practice needs to both understand and better manage the cost of more complex procedures, weighing whether the reimbursements you’ll receive
Strategy #4 – Ensure Documentation is Accurate and Complete
Missing documentation is one of the common reasons pain management claims get denied, so it’s important to make sure that documentation is accurate and complete before you send claims to payers. It’s important for records to show everything that took place in a patient visit, and physicians need to stay up-to-date on keeping well-documented operative notes to prevent problems with payer approval. Since most practices are using EHR systems, physicians must know how to fit new procedures into EHRs, particularly when there isn’t a template for some services performed within a pain management center.
Strategy #5 – Learn to Better Negotiation Contracts
When negotiating contracts, it’s important to be fully aware of the actual costs of various therapies being provided. Understanding your local marketplace, financial analytics, and the complexities that come with managing the business side of pain management is essential when you’re negotiating contracts with payers. In many cases, it can be helpful to have professional negotiators step in and negotiate for you to ensure you’re getting the best possible reimbursements from payers.
Strategy #6 – Consider Outsourcing Billing and Coding
Pain management billing and coding can be complex, and when it’s not done correctly, it can result in costly denials. Keeping your revenue cycle moving is important to growing your practice, and one of the best ways to prevent claims denials is to outsource your billing and coding to a professional company.
M-Scribe specializes in offering billing and coding services, ensuring that the proper codes are used to maximize per code collection and reduce denials to keep revenue flowing for your pain management practice. We also offer payer contract review and credentialing services to help reduce the administrative burden on your practice. Contact us today and find out how we can help you grow your practice and improve revenue with our services.