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.
2012 Medicare Payment Rate Changes for Physician Fee Schedule
On July 1, CMS (Center for Medicare & Medicaid) issued a proposed rule that represents a 29.5% cut to Medicare physician payments unless Congress steps in to correct it.
See the CMS press release at http://go.cms.gov/kssRvx
Dr. Donald Berwick, head of CMS was quoted in the press release saying, “This payment cut would have serious consequences, and we cannot and will not allow it to happen,” said Dr. Donald M. Berwick, CMS administrator, in a statement. “We need a permanent SGR fix to solve this problem once and for all. That’s why the President’s budget and his fiscal framework call for averting these cuts and why we are determined to pass and implement a permanent and sustainable fix.” Physicians groups have clamored for the SGR (Sustainable Growth Rate) formula to be overhauled as part of the deficit reduction process, but that would also come with a $300BB price tag.
Some provisions of the proposed rule include:
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Physician Quality Reporting System (PQRS) – adding 26 new measures
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Value-based modifier-CY 2013 as the initial performance year
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Meaningful use
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Misvalued code Initiative
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Payment for certain Part B drugs
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2012 e-prescribing incentive
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Multiple procedure payment reduction (MPPR)
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Physician payment during 3-day payment window
Comments are due back to CMS before August 30th. The final rule is expected by November 1st.
