Top Reasons Why Your Pain Management Practice is Struggling in Billing and Collections

As a pain management provider, you want to ensure that your practice is financially stable and that your patients receive quality care. That’s why medical billing is so important — it helps with reimbursement, tracks insurance coverage, and manages financial records. However, medical billing can be a complex process. These issues usually arise from complex billing and coding requirements, unstandardized treatment protocols, insurance limitations, and changing healthcare policies. It is also during this time when reimbursement issues in healthcare occur. 

Furthermore, the subjective nature of pain and varying patient responses to treatment can lead to claim denials and payment delays.

Top 5 Reasons Why Your Pain Management Practice is Struggling in Billing and Collections

Pain management practices face significant billing and collections challenges due to various factors. These may include:

1. Failing to Capture Patient Information Accurately

All healthcare journeys begin with your front-end staff collecting relevant information from your patients. Your medical billing process and pain management collections depend on this information.

If your pain management practice doesn’t get patient information accurately, it can create many problems. For example, the wrong diagnosis or treatment can worsen a patient’s condition or cause other health issues. You may also experience insurance claim delays or rejections in this situation.

According to a recent study, eligibility or qualification issues are the leading cause of claims denial, and almost 80 percent of all cases are rejected for qualified reasons. This study also found that providers weren’t asking patients and insurance agencies ahead the right questions regarding eligibility.

Read Why Checking Patients Insurance Eligibility Is So Important In Medical Billing

2. Neglecting to Inform Patients About Financial Responsibility 

If patient management practices don’t let patients know their financial responsibility, unwanted results can occur. Some of these are the following:

• Higher levels of medical debt: Unexpected hospital bills may surprise patients, and they may incur unpaid debts and collections if not informed of their financial responsibility. One study found that 1 in 6 Americans have past-due medical debt. In the United States, medical debt is a significant problem. 

• Decreased patient satisfaction: Patients who are surprised by their medical bills or feel like they need more financial information may feel less satisfied with their care. This situation can be a big problem in healthcare practices because patient satisfaction is crucial.

• Legal and regulatory consequences: As healthcare providers, you must inform your patients ahead of their financial responsibility. Failing to do so can lead to legal and regulatory outcomes, such as fines or other penalties. 

Therefore, neglecting to inform patients about their financial responsibility can lead to significant adverse consequences. To ensure everyone is on the same page about the cost of care, you must prioritize clear and transparent communication with your patients.

3. Handling Claims Management Processes Manually

Most healthcare providers in pain management still rely on manual documentation for recording injuries. One reason may be the familiarity and ease of use of traditional pen-and-paper methods. Sometimes, other providers prefer handwritten notes and documenting injuries on paper over digital tools.

Another reason may be the lack of access to or training in electronic health records (EHR) systems. Moreover, some may not trust the accuracy and security of these EHRs or may have concerns about the potential for errors or system failures.

4. Inaccurate Coding 

Did you know that inaccurate coding remains a top medical billing issue affecting both patients and providers? As a healthcare professional, you understand the importance of accurately coding medical procedures and diagnoses to ensure proper reimbursement and avoid costly billing errors. Mistakes are likely to happen due to medical coding’s complexity and frequent guideline updates. These errors can result in denials, payment delays, and potential fraud or legal issues. 

5. Using Outdated Software Technologies

If pain management practices use outdated software technologies, it can lead to several negative consequences. These technologies may not handle the complexity of modern healthcare systems. As a result, patients may receive the wrong dosage of medication or treatment that may cause them harm.

Furthermore, outdated software may not have the security features to protect patient data, putting their personal information at risk. In addition, it hinders your ability to make informed decisions about patient care when tracking their progress and treatment outcomes.

Overall, pain management practices with outdated software can risk patient safety and quality of care.

5 Collection and Billing Solutions for Pain Management Practices

Are you looking for ways to improve your pain management finances? Here are some collection and billing solutions to streamline your revenue cycle!

1. Outsourcing Medical Billing Services 

You can also consider outsourcing your pain management medical billing. Below are some of its great benefits:

• Minimize Errors

During the 2021 coverage year, insurers denied 41.7 million in-network claims due to inaccuracies in medical billing. The great news is that outsourcing can help reduce these errors! Third-party service providers will handle coding, HIPAA, and HITECH compliance and auditing when billing errors occur. If you outsource your medical billing, you can reduce the risk of RAC audits. 

Managing medical billing can be challenging, but you will succeed if you remain focused and accurate. Even minor human errors can lead to penalties, delays, and denied claims. 

• Better Transparency

As pain management providers, you have a unique advantage in medical billing with the help of your outsourcing partners. They ensure you comply with all regulations and stay transparent about your progress. You should keep your operations clear and accessible to your customers and employees by assigning a team leader and manager.

• Save Money

As a pain management professional, you are used to having a lot on your plate, leaving little time for medical billing. Fortunately, there’s good news! Medical billing outsourcing is an excellent way to save costs since it eliminates the need for office space, expensive equipment, and employee salaries. This option lets your provider handle all your team’s needs, so you can focus on patient care.

2. Investing in Current Medical Billing Software

Indeed, investing in current medical billing software is essential to avoid medical billing issues. Recent statistics show that 69% of providers had seen more denials since the beginning of the year, with billing, claims, and coding errors being the leading cause. With advanced medical billing software, you can reduce errors, ensure accurate coding, and improve claim submission. You can also provide better patient care and stay compliant with regulations. Investing in current medical billing software is worth it for your practice’s success.

3. Establishing a Strong Quality Control Process

Did you know that medical bills contain errors up to 80% of the time? It can cause reimbursement issues in healthcare, including delays or even denied claims, which are frustrating for patients and you. But don’t worry; there are ways to reduce your error rate and save time. By implementing strong quality control processes, you can ensure that submitted claims are accurate and complete.

Your practice management systems and clearinghouses must also be configured to stop or fix claims before submission automatically. You can avoid denied claims and improve your pain management billing collections by doing so. Make sure your quality control workflow is up-to-date, and your patients will thank you!

4. Adopting 2023 ICD-10-Compliant EHRs

As healthcare evolves, your pain management EHR software must keep up with the latest coding standards, such as the ICD-10 codes for 2023. When you integrate these codes into your EHR, you can provide more precise and detailed data on patients’ conditions. The ICD-10 codes will also help identify different types of pain and their causes.

As a provider, be sure that the software you use to manage pain is compatible with other healthcare systems. If not, it might hinder effective care delivery due to the inability to exchange data with other systems.

Therefore, pain management software must keep up with changes in ICD-10 medical codes to ensure that your chronic pain patients receive quality care.

5. Targeting Provider and Staff Training

Invest in practice management and EHR training for providers and staff to reduce burnout, increase satisfaction, and improve performance. Coding and documentation training can also improve the data quality your billing department receives. Remember to budget for training your medical billing specialists too! This training will help your pain management practice reduce charge lag times, boost accounts receivable, and lower claim denials. Overall, match training sessions to your team’s job roles and comfort levels to ensure they get the most out of it.

Providing you with the Best

Reliable medical billing and collections system is essential for pain management practices to do well financially and stay competitive. Luckily, this article provides some of our most effective strategies. When you have a solid solution in place, you can focus on delivering the best care without worrying about finances all the time.

Choose only the best for your pain management practice!

At 1st Providers Choice, we understand our client’s needs and expectations for higher billing and EMR software performance. That’s why we only offer the top-tailored medical billing system and EHR with features allowing your practice to operate at its optimum potential, save time, and double your revenue.

Call us at (480) 782-1116 for immediate assistance or schedule a free demo with our experts TODAY.