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We have delivered pain management billing for several practices and for several procedures. These commonly include interventional pain procedures (fluoroscopy, ultrasound-guided injections), mental health services (CBT, relaxation techniques), chronic condition management (arthritis, COPD, atrial fibrillation), complementary therapies (acupuncture, chiropractic care, occupational therapy), etc. Here’s how our team does it for you:
- Integrate Electronic Health Record (EHR) system, Electronic Medical Records (EMR), Electronic Data Interchange (EDI), and Practice Management Systems (PMS) into medical billing software to facilitate electronic claims submission and assist in receiving electronic payments.
- Collate comprehensive patient demographics (medical history and physician referral information) and insurance payer details (coverage type, prior authorization status (including effective and expiration dates, and claims address) to create accurate claims documentation.
- Maintain code specificity while dealing with diverse pain management billing models, including value-based billing, telemedicine billing, fee-for-service billing, capitation billing, etc.
- Ensure accurate coding and claims submission using the latest standards: CPT codes (00100-99499), HCPCS Level II codes (G3002-G3003), and 2024 ICD-10-CM diagnoses.
- Dedicate teams with specific expertise to bill for a wide range of surgeries and procedures like Epidural Steroid Injections (ESIs), Radiofrequency Ablation (RFA), Spinal Cord Stimulation (SCS), Sacroiliac Joint Fusion, Percutaneous Discectomy, Trigger Point Injections, Kyphoplasty, and more.
- Stay abreast of any changes to fee schedules or claims filing guidelines for insurance providers, including Medicare, Medicare Advantage Plans (Part C), Medicaid, Tricare FEHBP, Workers' compensation programs, and private insurers such as AthenaHealth, Blue Cross Blue Shield Association, and others.
- Received and validate EOBs from payers, resolve discrepancies, and proceed with the appeal process to get maximum reimbursement.
- Calculate clear and comprehensive breakdowns of out-of-pocket expenses (deductibles, copayments, and coinsurance). Inform the service covered and not covered to patients to enable price transparency and payment responsibility.
- Monitor key billing metrics such as clean claims rate, claims denials, collection rate, AR days, Days Sales Outstanding, etc. to improve billing accuracy.
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