ASC Pain Management Billing Services

Pain management is an important ASC specialty with over 15% of surgery center procedures classified as pain management (per the ASC Association). Trends in Medicare reimbursement have not been favorable for pain management ASCs. Despite this trend however, growth in ASC pain management procedures continues. Continued improvements in technology and drugs are important factors. Patients are also particularly receptive to outpatient pain management procedures versus the hospital alternative when multiple visits are required.


Skills required for ASC Pain Management Billing

Billing for ASC pain management procedures can be complex. Pain management represents a wide variety of procedures (some examples are listed below) and underlying causes (diagnoses). Payer rules vary and can be confusing. As a result, it is recommended that centers employ only experienced pain management coding and billing staff. Billing staff must be knowledgeable in coding, charge posting, claims filing, payment posting, customer service, A/R follow-up including denial management, and reporting.

Many centers find that attracting and retaining these skills in a relatively small staff can be a challenge. For this reason, hiring a firm who specializes in ASC pain management billing may be the best option. The right firm offers an ASC the ability to hire a team of experts, specialized and skilled in each of the billing disciplines, while only paying for a fraction of the costs. Since a professional ASC billing company performs coding and billing for many ASC’s, economies of scale are realized and passed along to clients. The volume of work justifies having specialists and experts and avoids the risk that an ASC faces with internal staffing: “jack of all trades, but master of none.”

Billing Considerations for ASC Pain management

Insurance underpayments are an issue for all specialties, but they can be particularly common, and troublesome, for ASCs specializing in pain management. Uunderpayments can represent 10% or more or a surgery center’s revenue. Multi-visit rules are one example where tracking payments is critical to assuring proper reimbursement.

Patient billing can also be an issue for pain management ASCs. Recurring visits can generate substantial balances (an average charge of over $2600 per case according to VMG Health, LLC)and payor reimbursements can be confusing for patients. Billing staff and procedures designed to minimize these roadblocks can be much more successful in collecting patient balances in a timely manner.

As everyone knows, pain management coding rules are constantly changing. The addition of new procedures and drugs(and their associated codes) is important. However, careful coding of common pain management procedures is even more important. At its most basic level, this means coders must carefully review the operative note and assure they’ve accurately and completely captured exactly what was done.