5 Areas in Pain Medicine RCM That Deserve Special Attention

Today, pain medicine is faced with falling revenue as patient behavior and insurance company guidelines chip away at the reimbursement you earn in treating patients. To complicate things further, we are experiencing a shift in how care is delivered due to a once-in-a-century pandemic.

So how do you protect yourself and your practice? By ensuring that your billing lifecycle is working at peak performance and nothing is falling through the cracks.

5 Areas to Focus Your Efforts

Losing revenue can almost always be traced back to operational systems and billing processes that need to be honed. Take, for instance, prior authorizations which impact everything from specialty pharmacy to durable medical equipment! 

Only 21% of practices use an automated prior authorization solution that alleviates much of the administrative burden that comes with a manual system. But practices have been slow to embrace the advanced technology available through cloud-based software, such as Infinx’s Prior Authorization Software solution.

1. Double-Check Insurance Eligibility – And Then Check It Again!

Securing accurate and valid insurance and demographic information about the patient is critical for the entire reimbursement process. By checking and re-checking eligibility, you can be assured that patients have valid coverage, and by using a transparent insurance verification and benefits eligibility automation package, your practice will be able to track and confirm precise patient coverage details in real-time while avoiding later denials due to ineligibility, including:

  • a patient’s eligibility and dates of coverage,
  • the primary or secondary insurance relationship
  • co-pay and/or co-insurance due,
  • annual deductible met and remaining, and
  • any out-of-pocket maximums.

Eligibility can change, and by checking it with each encounter, either by phone, for scheduling or telehealth purposes, or in person, you can be assured that you are operating with the best information.

2. Be Sure to Capture All Charges

It seems counter-intuitive, but charges often get missed when providers are rushed, familiarity has set in, or when providers choose not to chart within 24 hours of the patient encounter. Missed charges add up quickly and not only rob you of time spent but often supplies, medications, etc., that are inventory expenses of the practice.

Listen to your business team to discover if things are getting missed within your practice or, even better, perform a systems audit that follows the superbill from inception through claims management to identify any holes in your overall process.

3. Collect All Patient Portions Due Up Front

Patients are absorbing more and more of the financial responsibility for their care, and hospitals and healthcare providers need to be proactive in educating them on their increasing financial role. It has never been more important to set the expectation that patient portions are due before the service is provided. An effective way to enhance the process is with real-time estimates delivered prior to any scheduled care, which 90% of patients will willingly pay, especially when given online payment options.

4. Monitor the Coding and Billing Function

Whether this is done in-house or by a third-party RCM partner, it’s important to routinely monitor the medical coding and billing process from start to finish. This means that once the patient encounter is complete, the superbill is followed through the coding function, the claims submission process, and finally through A/Rs and collections, if necessary.

It’s important to have a trusting relationship with employees and third-party partners, but it’s also key to verify that the job is being completed satisfactorily. This gives you peace of mind while ensuring your team is properly trained and well-functioning.

5. Be Sure to Measure Your Key Indicators

Several key measurements give you a bird’s eye view of how your practice is running. Keep a careful eye on these numbers:

  • Daily Net Production (charges – payments – adjustments + refunds)
  • Monthly production by provider
  • Outstanding A/R breakdown
    • ARs over 90 days below 25%
  • Number of claims denied and the reason why
  • Missed appointment and no-show rates
  • Overtime hours

For pain medicine practices, it’s important to verify that business functions are working seamlessly and audit systems are in place to ensure that workflow is being performed as set in your policies and procedures. As in any organization, turn-over happens, and systems can be interpreted differently or changed without your knowledge. By being proactive, you can be sure that your office is running as intended.

Contact us today to learn more about our automated, real-time Insurance Verification and Benefits and Patient Payment Estimation solutions for your pain medicine practice.

About the Author

Infinx
Infinx Healthcare provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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