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Specialty — Pain Management

Medical billing and RCM for pain management practices

Pain management sits at the center of payer utilization review, which makes authorization discipline and medical-necessity documentation the whole ballgame.

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A physician using a spine model to explain back pain to a patient
Denial drivers
Medical necessity, authorization
Coding pressure
Injection levels, guidance
Where A/R ages
Procedure claims
Underpayment risk
High
The challenges

What actually costs pain management practices money

Utilization review

Payers limit frequency and require documented failure of conservative care.

Injection coding

Levels, laterality and imaging guidance all change the code and the payment.

Authorization per procedure

Each procedure needs its own approval, tracked separately.

Frequent policy changes

Coverage policies change often and denials arrive in clusters.

How we work a pain management account
  1. 1 Medical-necessity documentation checked pre-submission
  2. 2 Per-procedure authorization tracking
  3. 3 Injection coding reviewed by specialty coders
  4. 4 Policy-change detection through denial clustering

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How healthy is your pain management revenue cycle?

We will review your denials, A/R and payer performance and tell you what we find.

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  • No patient information needed to start
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