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.

OIG Finds Inappropriate Medicare Payments for Epidural Injections

ASA Alerts August 25, 2010.  A recent report issued by the Office of Inspector General (OIG) found that Medicare Part B physician payments for transforaminal epidural injections increased nearly 150% from $57 million in 2003 to $141 million in 2007.  Further, according to the OIG, 35% of transforaminal injection services allowed by Medicare in 2007 did not meet Medicare requirements, resulting in approximately $45 million in improper payments.  An additional $23 million in associated facility claims was allowed by Medicare.  Finally, OIG found that services provided in offices were more likely to have a documentation error than those provided in ASCs or hospital outpatient departments.

Based on the review, OIG recommends that CMS conduct provider education, directly and through contractors, about proper documentation and strengthen program safeguards to prevent improper payment for transforaminal epidural injection services.  In addition, OIG recommends that CMS take appropriate action regarding the undocumented, medically unnecessary, and miscoded services identified in the sample.