Anesthesiology specialists are grappling with increasingly stringent payer policies that have led to inconsistent reimbursement when treating chronic pain. As the costs associated with practicing medicine continue to rise and the cut to Medicare reimbursement looms, accurate coding is paramount to physicians' reimbursement.
The Medicare Economic Index, which measures medical practice cost inflation, increased 4.6% in 2023, the highest in the last 23 years.
In light of this, Anesthesia Business Consultants shared its strategies for maximizing payer reimbursement in a Dec. 4 post on its website.
Here are three considerations the organization recommends when providing care for chronic pain patients:
1. Payment for certain codes related to chronic pain nerve blocks by default pays what is considered necessary for the typical patient when undergoing such procedures.
In more complex cases, such as where the condition of the patient, the location of the block or other issues call for more comprehensive anesthesia, practices must consider whether the payer will provide reimbursement on a case-by-case basis.
2. An advanced beneficiary notice or similar agreement with the patient that they will personally cover any unpaid portion of the service may prove beneficial, according to the post.
3. In recent years, coding options for chronic pain claims have changed. Providers must make sure they properly code for every service rendered. For example, in nerve block procedures, they must ensure that the claim notes that it was performed with guidance to be properly reimbursed, even though that may be a given to the physician themselves.
Overall, practices should monitor payer policies to be properly paid for services provided, according to Anesthesia Business Consultants.