1. Figure out where your cases will be most profitable. Pain management physicians who aren’t employed at a hospital need to analyze their cases to see where they will be most beneficial. “Not all cases are great cases for ambulatory surgery centers,” says Brice Voithofer, vice president of ASC and anesthesia services for AdvantEdge Healthcare Solutions. “Some cases are better for hospitals or clinics. The way to determine where your cases will be most profitable is to understand your case contracts and know what the yield is for each case.” Don’t schedule cases that aren’t yielding enough in the ASC if you are able to perform them elsewhere.
2. Keep implants in mind when negotiating payor contracts. Some pain procedures require expensive implants and if payor contracts don’t reflect a competitive rate, you won’t make money on those procedures. This might include carving out these procedures or implant rates within the contract, says Bill Gilbert, vice president of marketing for AdvantEdge Healthcare Solutions. “Make sure that expensive items like implants are appropriately reflected in the rate that is being paid by the payor,” he says.
For example, you might have a contract for $10,000 with a payor for a particular procedure, but they don’t carve out an implant that costs $7,000, which means your actual revenue is much less than the amount reimbursed. A contract with another payor that does carve out $8,000 for implants might be more attractive.
3. Have expert coders for pain management. Pain management, especially for orthopedic and spine pain patients, has a lot of innovation and some new procedures might not be covered by all payors. Physicians should be aware of which procedures an insurance company considers experimental to avoid denied claims and loss of revenue. However, practices can bill an unlisted procedure code for some new technologies. Coders must be familiar with the technology and procedure to fully utilize unlisted procedure codes. “You need to know how to bill for experimental procedures, and be able to say ‘Here’s why we used the code for this patient’ to the payor,” says Mr. Voithofer.
4. Be prepared for denied claims. Practice coders should also know how to handle denied claims. Claims are denied for a multitude of reasons, and coders may need to refer back to physicians to get updated information. If a procedure is done differently than usual, the coder must know the reasoning behind this change to receive reimbursement from the insurance company. “If the surgery is done in a different anatomical position for one reason or another, there are different units for pain management reimbursement,” says Mr. Voithofer. “Make sure the coders know what you are doing because correct clinical documentation can speed up the payment process.”
An ongoing dialogue between coders and pain management physicians is essential for an effective billing process. “The physician shouldn’t be surprised when they get questions from the coders,” says Mr. Gilbert. “Have a process in place for communication because billing and coding is complicated. There needs to be a dialogue in place for an effective billing process.”
5. Train staff in patient collections. Pain management physicians must have a staff trained in the best methods for collecting from your patients. The scheduler should know whether patients have an outstanding balance when they call for a follow-up visit, and if they do, ask them to send the payment in prior to the visit. “The front desk staff needs to be trained in collection procedures because most people naturally aren’t very comfortable asking for money,” says Mr. Gilbert. “Have a script written up for the front desk staff so that when they ask for patient payments, they begin with the assumption that patients are going to pay.” This might mean asking the patient which type of credit card they’d like to pay with instead of asking how they would like to pay.
6. Confront the patient yourself about payment issues. Patients visiting pain management practices see their physician as the ultimate authority figure, versus the front desk employee or a billing person calling the patient for outstanding payments. “Many times pain management physicians will be willing to confront their patients because they have the business in mind,” says Mr. Voithofer. “Practices should have a process to have the pain management physician spend 10 seconds to bring the payment to the patient’s attention, when that is warranted.”
Learn more about AdvantEdge Healthcare Solutions.
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