Primary care providers, seeking to improve patient care and outcomes, are finding more and more opportunities to use pain medicine early to break the pain cycle in difficult cases, e.g., lower back pain, fibromyalgia, migraines, etc. This, in turn, creates growing problems for insurance payers who are trying to contain costs and ensure medically sound and appropriate patient care is being delivered.
Once a patient is seen, the first step is to determine the accurate codes and service levels. However, whether it’s due to lack of time or chart completion expectations, procedures and testing are often under coded, miscoded, documentation is missing, or service level is misclassified. This causes severe problems that impact revenue, including denials, underpayment, and abandonment of claims.