Medicare Requires Revalidation of Physician Provider Enrollment Data

Medicare is requiring all physician providers who were enrolled prior to March 25, 2011 to revalidate their enrollment data. Between now and March 2013, Medicare fiscal intermediaries will be sending notices to these physician providers, requesting that they revalidate their provider enrollment information contained in the PECOS system. Upon receipt of the revalidation request, physician providers will have 60 days from the date of the letter to submit completed enrollment forms. Failure to submit the enrollment forms as requested may result in the deactivation of your Medicare billing privileges. Providers can now utilize the Internet-based PECOS (Provider Enrollment, Chain, and Ownership System at to revalidate their provider information.

Physician providers who fail to revalidate their data timely could suffer financial hardship due to the interuption in Medicare payments until the revalidations is completed.

5 Best Practices for Pain Management Billing and Collections

Here are five best practices to improve the billing process for pain management physicians.

1. Figure out where your cases will be most profitable. Pain management physicians should analyze their cases to determine the most profitable place of service (POS) for each procedure they perform. Not all cases pay well in all locations. Schedule cases in the location that pays best.

2. Keep implants in mind when negotiating payer contracts. Some pain procedures require expensive implants and if payer contracts don’t reflect a competitive rate, you won’t make money on those procedures. Carve-out the procedures that include an implant to ensure better rates within the contract.

3. Have expert coders for pain management. Pain management professionals utilize a lot of new innovations and procedures. Physicians should be aware of which procedures an insurance company considers experimental to avoid denied claims and loss revenue. Coders must stay current with the latest technology and procedures to optimize the reimbursement for the pain practice.  

4. Be prepared for denied claims.
Billing staff and coders should know how to handle denied claims. Claims are denied for a multitude of reasons and coders may need to refer back to the physician for clarification. If a procedure is performed differently than usual, the coder must know the reasoning behind this change to support reimbursement from the payer. Accurate clinical documentation will always provide support to your staff when appealing denied claims.

5. Train staff in patient collections. Your staff must be trained in the art of persuasion. This might mean asking the patient which type of credit card they’d like to pay with instead of asking how they would like to pay. Collecting from the patient in person is an art form. Your scheduler should indicate all outstanding balances when a patient calls to set-up a follow-up visit. Physicians should not be shy about asking their patient to settle their outstanding balance prior to leaving the office.  Collections from the patient should be a team effort.