7 Medical Billing and Coding Tips for Spine and Pain Management

We all know how important is medical billing and coding for specialties when it comes to revenue cycle management. Fine, there are good days and bad days where your revenue falls at risk sometimes and brings you profits the other days! But revenue loss really aches! With so much of effort and pressure, if handling patients doesn’t go well, you’re doomed!

Keeping things a side, do you think medical billing and coding for Spine and Pain management drives you to profits and faster revenue payments without extra focus? Most of the healthcare professionals can’t afford to make coding errors. Alright, we read your face! You will need to follow below tips to have an extra bonanza this year!

Let’s check those 7 medical billing and coding tips for Spine and Pain management.

1.Identify Claim Payers:

We are heading towards environment with more self-funded employer groups. So, it’s obvious to know who is paying the claims.
If it’s a self-insured group plan, the employer will have chances to assume financial obstacles before providing healthcare benefits to its employees.
Only 26% percent of employers are self-insured compared to the rest of 82% employers with 500 or more employees.
Predominantly, a greater number of self-insured companies have been established to start or implement self-insured plans.
In some cases, the risk level is too high for small businesses to compete and it can have negative impact on revenue. As a result, the employer loses a portion of reimbursement.
Having proper knowledge on payers and who is paying these medical claims is essential for preauthorization staff in order to submit accurate entries in timely schedule.
Medical billing and coding doesn’t become easy without these formalities handled better in many better ways. Than being unaware of payers paying the claims, it’s good and safe to learn who is responsible for your claims.

2.Proactive Denial Management:

Proper understanding on insurance rejections is very crucial to address and identify problems of revenue cycle management.
Claim denials alerts an array of medical billing and coding mistakes that include errors in demographic details, incomplete and improper claim submission, inaccurate modifiers and diagnostic codes.
With detailed analysis of claim denials especially on back end revenue cycle management, healthcare professionals and medical billing and coding companies will be able to extract actionable insights, target those bottlenecks as well as implement new and improved strategies for documentation.

3.Properly Understand Out of Network:

Out of network professionals got to be more energetic, thoughtful and organized to enjoy success in the current complex out of network landscape.
Several insurance companies are using innovative strategies and creative means to battle payment requests from out of network healthcare professionals.
It also means that healthcare professionals and medical billing and coding companies should have complete understanding on out of network policies for each patient and also stay tuned for policy changes until the treatment is completely rendered.

4.Medical Billing and Coding Strategies for Coders:

Coding errors and missed opportunities can become too shady because of many issues.
Medical billing and coding strategies for coders can enhance Spine and Pain management documentation by following the below.

5.Keep yourself familiar with CPT codes and Anatomy:

To maintain constant revenue reimbursement rates in Spine and Pain management, the most essential thing for medical billing and coding companies is to get familiarized with both anatomy and CPT coding sets.
Being well educated on complete anatomy enables medical billing and coding companies to interpret accurate surgical notes for surgical approach, level assignment as well as diagnosis assignment.
Medical coders can the rely on most accurate CPT codes available by ensuring healthcare professionals receive complete payments for rendered services.

6.Stay updated on Changing Policies among LCD and Commercial Payers:

Several insurance companies require substantial information and documentation in order to support medical necessity before approving authorization process.
It does not create much hassle but differences in medical necessity policies between insurance companies may become more stringent for medical billing and coding teams to navigate.
For example, the local coverage determinations of medical necessity for Medicare authorization may rapidly differ from the requirements set by commercial insurance companies.
There are cases where commercial insurance companies would require additional information or detailed and substantial information. Then, it’s the time to implement a system just to track those changes to medical necessity policies.

7.Obtain Detailed and Accurate Physician Documentation:

It’s essential to provide complete and detailed operative notes in order to ensure whether medical billing and coding companies are able to indicate CPT designations.
In Spine and Pain management, decompression documentation is must which specifies each nerve targeted at each level for maximum reimbursement rates.
Spine surgery CPT codes also may relate to another surgical approach. New, less and invasive surgical technology has transformed the procedures of Spine and Pain management.
To appropriately code for a new surgical approach or treatment, medical coders should learn and understand whether new techniques are considered open for endoscopic procedures.
The documentation should provide clear picture and complete information required for medical billing and coding services for Spine and Pain management.

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