Billing is considered as one of the major aspects of pain management clinics. It includes sending bills to Medicare or private insurer for the services the patient gets. However, billing errors cause several complications to make sure no issue occurs. The billing problems take a lot of time to solve, otherwise it can lead to claim denials. Hence, let’s dive into the top seven problems faced by the clinics and then how the pain management billing services solve those. So, let’s go to each of these mistakes one by one.
Problems Faced by Clinics
There are several problems clinics face, starting from using inaccurate codes to not following up on the denied claims. All the problems are described below:
Using Inaccurate Codes
Coding is an important part of pain management clinics. The billing codes are the numbers which tell the insurers what type of treatment providers gives. However, pain management, injections, radiofrequency ablation, and nerve blocks incorporate special codes. So, using the wrong code makes the billing process extremely complicated. Hence, it happens when the billing staff doesn’t know new codes or mix them up for different treatments. To counter this, you need to update your billing books with the new codes and double-check the work before sending a bill.
Missing Important Modifiers
Modifiers are codes showing the details of insurance companies about the treatment. Here, if you use the wrong codes, it can cause payment issues. Sometimes, the staff forgets the requirement of a modifier and other times, they may not know why to use that also. Always remember that without the right modifier, companies may pay less money. So, you need to learn which modifier is used for pain management treatments. Moreover, you also need to create a checklist to see if a modifier is needed and train your staff regularly using the correct codes. Hence, it is why you need the help of pain management billing services for that matter.
Not Checking If the Rules Are Right or Not
Insurance companies, such as Medicare, often change billing rules. So, checking all these changes may lead to several mistakes. Insurance rules are changed almost in every year. So, if you don’t keep up with the rules, you need to use old information. For instance, if the code was paid a good amount, the rules may change. So, it can make you lose a large amount of money. You need to read updates and newsletters from other private companies and Medicare. Moreover, attend training sessions and workshops and have regular meetings with the billing team to talk about rule changes.
Incomplete Patient Information
When a bill is created, it should have all the correct information about the patients. It includes patient’s name, insurance number, date of birth, and many more. Here, tiny mistakes can cause claim denials. It happens when there is a rush to send bills and forms are not completely filled out. For instance, if the patient’s insurance number is wrongly written, insurance companies don’t know who to bill for and what they should not pay at all. So, always check if the patient’s information is written correctly or not, then use the patient’s details checklist and ask patients to verify their information.
Inadequate Documentation
Inadequate documentation means not having so many details about the treatment procedure. So, even if some of the procedures are done, it may be missing important information pieces which insurers need to make sure no claim denial occurs. So, you need to know that the doctors write notes on why the injection is needed and how the patient responds if a patient receives an injection. Hence, teach staff precisely what needs to be documented for each treatment. Furthermore, use templates in the EHR system to make sure all the details are captured. Here, the assistance of pain management billing services comes in handy.
*Duplicate Billing
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Duplicate billing is required when the same service is billed for more than one kind of visit. Hence, it leads to audits and fines. So, it happens when the staff members work in the same case and send bills for the same service. So, imagine a patient having a pain injection. Hence, if different people bill for that injection, insurers may pay twice. Here, you need to use software to flag duplicate entries and keep a clear service list to know what has been billed already.
*Failing to Verify Insurance Coverage
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Always ensure that the insurance is active and covers all the bill. So, if you fail to verify insurance coverage, it leads to unpaid bills which the insurer may not cope up. So, if you want to avoid it, verify insurance details when a patient checks in. Moreover, check the insurance coverage and ask patients to show the current insurance card.
How to Choose the Right Pain Management Billing Services to Tackle This?
As there are so many companies out there, how can you choose the right expert for your clinic? So, before choosing any expert, check if they help with entering patient demographics, eligibility checks, coding service, billing charge entry, claim submission, rejection analysis, and AR follow-up. Moreover, these companies help with affordable pricing, highest productivity standards, dedicated assistance, and excellent testimonials. These companies work with 99.9% accuracy and reduce your operational costs by 80%. Professional companies also help dedicated account managers at no extra cost and have no binding contracts.
These companies stay updated with all the CPT, ICD, and HCPCS codes to make sure no issue occurs. Moreover, they also know all the complex nuances of the HIPAA law to protect patient data. Apart from that, these companies verify patient insurance eligibility, collect important documents, and then streamline prior authorization requests to make sure no issue occurs. They also don’t need any training or office space, which is one of the main reasons to hire them. So, if you want to streamline your billing process, it can be a feasible option to hire pain management billing services for that matter.
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