Pain Management Medical Billing: Guidelines and Updates

pain management medical billing

Millions of Americans suffer from some form of chronic pain. This public concern costs healthcare providers billions every year. As a result, pain management medical billing is increasingly becoming more complicated and expensive. 

New state and federal regulations and guidelines add to this complication. This guide explores the unique challenges medical billing services face and how proper pain management practices can overcome them. These practices can also help prevent physician burnout causes

Challenges a Pain Management Practice Encounters

Pain management practice and billing face many challenges, some resulting from new guidelines and laws. Some of these challenges are: 

Prior Authorization

Many insurance companies stipulate that healthcare professionals must obtain prior authorization for administering pain management solutions, like trigger point injections. 

Insurance companies may only approve resolutions when there’s proof that other treatments haven’t succeeded. Insurance companies may also require prior authorization for prescribing pain medications as well. 

The 21st Century Cures Act

The Cures Act also impacts pain management medical billing. For example, a healthcare facility’s RCM must handle specific CA necessities. 

One requirement involves installing a CA app compliant with SMART/FHIR capabilities. Patients should be able to download this app on their Android or iOS devices. This app can make handling your facility’s operations significantly easier, including possible features like: 

  • Healthcare workers will receive alerts about patients checking into the emergency room and again when the hospital discharges them. 
  • Patients will receive in-office and telemedicine schedule reminders. 
  • Patients can quickly fill out questionnaires after being discharged. 
  • Your RCM company can have a portal where patients can quickly make payments. 

Prescriptions and Procedures Limitations 

Healthcare professionals must prove that specific treatments or medications are necessary for a patient’s health. Additionally, healthcare workers may only be able to perform certain procedures in a set amount of time. 

These limitations can slow pain management medical billing. A system where healthcare professionals can easily access a patient’s data can help ease this burden. 

An Attempt to Reduce Medication Dependency 

Many see patients’ dependency on medication as an epidemic. As a result, medical organizations and insurance providers are trying to reduce medical dependency. While a positive in many cases, new guidelines make prescribing medication harder. 

Insurance Companies Are Also Overwhelmed 

All the new billing reforms aren’t just overwhelming hospitals and organizations. Insurance companies are also overwhelmed by the new guidelines and the time it takes to review every claim. 

Ways to Increase Pain Management Billing Revenue

Medical facilities must adapt to these new changes, and some strategies are: 

  • Making sure every staff member understands the latest codes and payer stipulations. 
  • Analyzing the most significant medical coding issues a facility has, as these issues lead to the most denials. 
  • Updating ICD-10 and CPT codes, as there are constantly new codes, revisions, and deletions. 

An Easier Process with PracticeForces

Pain management medical billing presents significant complications, especially since state and federal guidelines change yearly. Trying to stay up-to-date while running a facility can be stressful. Our PracticeForces team can help eliminate this stress. 

Clearwater, FL, medical organizations can discover home health billing basics by calling us at (727) 499-0351.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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