When left untreated, acute pain turns into chronic pain, causing you discomfort for life. Thankfully, people are waking up to this realization. Hence, the demand for pain management services is rapidly growing across the country.
According to research, almost 20.9% of U.S. adults suffer from chronic pain, and 6.9% experience a higher impact. Due to this fact, the requirement for pain management practices has increased. The market may grow by 3.1% CAGR and reach USD 97.4 billion by 2032.
In today’s guide, we will discuss several challenges in running a pain management practice and how you might address them without sacrificing patient care.
Challenges
Running pain management practices is just as challenging as treating chronic pain. Every pain management practice encounters challenges that could affect it financially. These challenges may include complex coding requirements, delayed prior authorizations, frequent claim denials, and compliance risks.
Prior Authorizations
Pain management practices must acquire prior authorization from insurance payers. Additionally, every insurance company has its own rules and electronic systems that administrative teams and physicians find challenging to understand.
Prior authorization is complex and time-consuming, especially for complicated or experimental treatments. Physicians find it increasingly challenging to write the appropriate prescriptions for patients since an increasing number of painkillers and therapies now need to pass the pain medicine prior authorization process.
As a result, physicians, nurses, and administrative personnel spend more time submitting and monitoring prior authorizations for medication before patients can receive injections and prescription drugs, which adds to the administrative burden of investigating and addressing requests for additional information.
Claim Denials
Claim denials are the most common challenge that almost every practice faces. This may cause revenue loss for healthcare practices, which means the insurance payers refuse to pay for rendered services.
Every rejected claim is an administrative burden that takes time and money to resolve, in addition to being a missed payment. The denial can occur for various reasons, such as incorrect coding, a lack of information, or problems with patient eligibility.
Overcoming these obstacles requires keeping up with billing regulations and putting in place efficient denial management techniques. Practices must ensure the patient’s pain status is accurately reflected in the diagnosis coding using ICD-10-CM.
It is essential to comprehend pain management claim denials to speed up the resolution, boost revenue collections, and prevent further claim denials.
Regulatory Non-Compliance
Pain management practitioners must be aware of the most recent regulations and limitations established by the government. Otherwise, they may have to pay heavy fines that the regulatory body imposes as penalties.
For example, practices use Opioids for pain management under strict regulations. The U.S. Centers for Disease Control and Prevention (CDC) is limiting the prescription of opioids because it has been one of the significant reasons for deaths over the last 20+ years.
On the other hand, since pain management is a sensitive department, there are hazards associated with managing pain, especially when prescribing controlled drugs. Hence, practices must maintain proper documentation, accreditation, or certifications to comply with industry standards. Implementing strict risk management procedures and keeping thorough records can help practices avoid non-compliance and legal problems.
How Do You Deal with Challenges?
The following tips will help you speed up your healthcare claims processes and develop an efficient claim denial management strategy for pain management billing:
AI Tools and Automation
Artificial intelligence (AI) and automation technologies have transformed medical billing services for small practices. The latest billing software automates code verification, claims submission, and reimbursement tracking.
These can swiftly process and analyze big data and spot upcoming trends and possible denials, guaranteeing accurate and timely resubmission of claims. Eventually, it improves the organization’s overall financial health and reduces the reimbursement collection time.
Staff Education and Training
Medical billing requires specialized coding knowledge, efficient claim monitoring, and adherence to ever-changing legal standards. These issues must be addressed through employee training to ensure that the billing staff has the necessary skills.
Hire qualified medical billers and coders with experience in revenue cycle management services, including denial management, to handle your payment conflicts.
Regular Audits
Conducting routine audits can help find patterns and areas for improvement. By knowing the reasons behind claim denials, future procedures can be improved, and providers are less likely to run into the same problems. This proactive strategy can drastically reduce denial rates and improve overall revenue. If your practice lacks in-house expertise, it is always a good idea to hire an expert for medical billing audit services.
All-in-One Solution
We have summed up a few challenges that most pain management practices face. However, there are more challenges that practices must overcome, such as burnout, staff shortages, complex coding, keeping up with technologies, and the list continues.
We have offered some advice that might help you overcome some of these obstacles. Nevertheless, acquiring professional medical billing services is an all-in-one solution. These third-party billing companies handle patient appointments, file claims for payment, and fight denied claims. You can focus on delivering exceptional patient care without worrying about the billing process.
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