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Pain management is a branch of medicine with an interdisciplinary approach to relieve pain and improve the quality of life of the people suffering with pain.
Pain affects more number of people than heart diseases, cancer and diabetes, and nearly 100 million people suffer from chronic pain in United States, according to the Institute of Medicine's 2011 report.
Pain management practice often needs coordination along with other practitioners. This helps in improving the quality of care provided and this is only possible when providers are not spending all the time on office tasks.
Rely on us expertise in billing pain management can help you with your complexities related to office-based activities and achieve desired outcome for the services rendered. Ultimately it is the cash flow that enables a business to stay open by being compliant and ethical in all the processes of revenue cycle.
Coding pain management services is getting more and more complicated year by year in part because of renewed medical interests and pain management guidelines. Coding for chronic pain treatments is attracting critical observation by payers and regulators. And therefore, it is crucial that providers maintain precision in their documentation ensuring medical necessity and treatment options are well highlighted.
We understand your concerns and can assist to strategize with you to create solutions for reimbursement. We are here to provide feedback and regular updates for pain management specialists in having an appropriate documentation in place that can survive an audit.
Prior authorizations: With increasing prescribing of medications by the physician, the chances of getting prior authorization requests approved, solely depends on the physician’s documentation.
Although insurance companies eventually authorize, it’s a lengthy administrative task of recurring paperwork, making multiple calls and bureaucratic battles that can delay patients care. The burden increased exponentially after the payers new requirement for prior authorization for prescribing of generic medications too.
Inaccurate or over documentation: It is easy to inflate documentation in EHRs triggering a coder to pick higher level of E/M service than what is warranted. However, volume of documentation should not be the influencing factor in selecting a code. It is the medical necessity and the service offered that should be of prime focus and documentation must support the level of service billed. Inaccurate or over documentation always has a negative impact in selecting an appropriate code which directly or indirectly triggers an audit.
Regular updates or changes in CPT codes, LCD guidelines and fee schedule: With ever-changing guidelines in CPT®, LCDs and fee schedules in pain management, it is crucial for coders and billers to stay up-to date with the changes, helping your practice from losing revenue.
Here are few examples –
Updated fee schedule(Final 2017 Clinical Laboratory Fee Schedule)- There is a significant rise in reimbursement rate for definitive drug testing codes
G0480 – from $79.950 to $116.85
G0481 – from $123.00 to $159.90
G0482 – from $166.05 to $202.95
G0483 – from $215.25 to $252.15
Deleted codes- CPT® G0477-G0479, Presumptive drug testing codes have been replaced with the codes ranging from 80305-80307.
Moderate sedation – Moderate sedation is no more a bundled service and it can be reported separately whenever medically necessary and the code requirements are met. CPT® 99143-99145 and 99148-99150 have been replaced with the new set of CPT® 99151-99153 and 99155-99157. Time requirements have also been changed from 30 minutes to 15 minutes to report 1 unit of service.
Bundled Procedures: Proper knowledge in NCCI policy manual and their updates helps us in correct coding and keeping away from denials and negative audit findings. For example: Nerve blocks used for intraoperative pain management is considered to be a part of anesthetic service and must not be reported separately. While nerve blocks used for post-operative pain management can be billed separately.
Frequency limitations: Chronic pain is a condition that lasts for long time. There are many options for the management of pain. Interventional pain management is one of the treatment modalities which involves invasive techniques such as nerve blocks, facet joint injections, trigger point injections, etc. These procedures have their own frequency limitations. Services performed without any awareness on the frequency limitations will have a direct impact on reimbursement by receiving denials or recoupment of the amount. Below is an excerpt from Medicare LCD policy detailing the frequency limitation for Lumbar epidural injections:
No more than 3 epidurals may be performed in a 6-month period.
No more than 6 epidural injection sessions (therapeutic epidurals and/or diagnostic transforaminal injections) may be performed in a 12-month period regardless of the number of levels involved.
If a prior epidural provided no relief, a second epidural is allowed following reassessment of the patient and injection technique.
All time intervals are determined on a rolling basis. For example, the limitation of coverage to six sessions in a year refers to a rolling 12-month period. The year begins with the first session and completes one year later. The next rolling year begins with the first session after completion of the preceding rolling year.
Proactive Prior authorization: Our team can help provider get prior authorizations approved by the payers by proactively advising our clients on medical necessity, frequency limitations, medically unlikely edits, bundled procedures, etc which strengthens the documentation thereby minimizing time in receiving prior authorization.
Stalwart Leadership: Pain management is a specialty with intricate guidelines requiring a team of robust experience and knowledge to handle the process. The success of any process depends upon the team we create and Rely on us has such a promising team who would inevitably bring a phenomenal change in your business revenue in-flow and we have proven records that set standards for our credibility.
Transition Strategy: We have live examples with our existing clients where we had come up with exclusive strategies for a smooth transition from onshore.
Consistency: With the dynamism pain management practice runs with, we are capacitated with a stable team with low or no attrition ensuring we maintain the consistency in our deliverables.
Sustainability: Sustainability is not part of our work- It’s a guidance influence for all our work. Rely on us has a dedicated team who are trustworthy and experienced to handle huge volumes of your practice with quality outputs.