According to the study of the American Academy of Pain Medicine, millions of people in the United States experience acute or chronic pain. Moreover, such pain has become a public health issue that costs society billions of dollars per year.
With so many people affected by pain, there is plenty of space for pain management billing services to expand their operations. However, new state and federal legislation have created several specific obstacles for pain control procedures in recent years.
Payer reimbursement guidelines and coding revisions have made the revenue for pain treatment billing activities more difficult. However, once you realize some of the difficulties the practice is facing, there are methods you can put in place to start raising sales amid these obstacles.
Some of the most unique challenges faced by the Pain Management billing services in recent times:
- Prior Authorization
Many payers now require doctors to obtain prior authorization before administering such pain relief services, and permits are only granted if there is medical need or evidence that more conventional treatments have failed. This includes the need for prior authorization for the majority of pain medications.
- Analysis of Post-Service Prepayment Coding
Post-service prepayment coding reviews can occur, delaying payments for up to 180 days if claims are flagged for further review. This makes it impossible to maintain the sales cycle.
- Restrictions on the use of drug combinations
When it comes to prescribing certain complicated medications or drug formulations, doctors must have evidence that the treatment is necessary. Moreover, they should also justify that the combination is known to be appropriate for the patient.
- Some Therapies aren’t reimbursed
Certain non-pharmacologic therapies for pain that are recommended by the CDC and other organizations may not be reimbursed by certain payers.
- Payers are overburdened
Payers are often overwhelmed by a large number of pain relief claims. Moreover, the review process is extremely time-consuming. In certain cases, payers hire beneficiary consulting firms to handle their approvals.
- Procedure limitations
Physicians are often restricted in the number of times they can perform such procedures.
- A Growing Epidemic of Pain Medication Dependence
In the United States of America (USA), there is an increasing epidemic of patients becoming dependent on pain medications. Payers and other groups are attempting to minimize the issue in order to combat the epidemic. This has resulted in some doctors being targeted for overprescribing certain forms of drugs.
The functions of the Pain management billing services are extremely complex. Certain minor errors can result in huge losses and costly claim denials. Hence to conclude, to avoid the unique challenges mentioned above, it’s imperative that you outsource the pain management billing services to a competent company. A competent organization should have an extremely skilled workforce and the staff has an in-depth knowledge about the ever-changing guidelines.
