Pain Management Practices: Growth and Roadblocks
As pain management practices scale, it becomes more and more difficult to increase revenue cycle efficiency and drive revenue growth. Maximizing reimbursements in pain management is crucial, but the complex coding requirements surrounding different treatments, medications, therapies, and services offered increase room for error.
To best maximize reimbursements in pain management, revenue cycle teams must focus on not just minimizing denials and underpayments, but proactively predicting and preventing denials and identifying trends, changes in payer rules, and underpayment patterns.
One of the biggest roadblocks to reimbursement in pain management is the overarching challenge presented by non-opioid pain care and therapies. Let’s dive into why these therapies present such a challenge and how teams are addressing this roadblock.
Non-Opioid Care: RCM Challenges and Solutions
Prior Authorization
Revenue cycle teams are no stranger to prior authorization requirements. No matter what specialty you work in, many treatments and services require prior authorization. In pain medicine, this is especially true for non-opioid care and treatments.
In pain management, non-opioid care almost always requires prior authorization. In fact, in a survey run by the American Board of Pain Medicine, 92% of pain specialists reported that they were required to obtain prior authorization for non-opioid pain care, delaying treatment and requiring additional staff to process the workload.
Not only do these prior authorization requirements result in a need for more staff and increase the chance of denials, but they also significantly delay patient care. In pain medicine, the patient is almost always there because they are in pain — the longer it takes to provide services, the longer it takes for the patient to start feeling better.
The solution? A revenue cycle platform that can help teams stay one step ahead of prior authorization requirements. For example, Adonis Intelligence prevents downstream denials through algorithms that analyze your revenue cycle and alert you to anomalies, prior authorization requirements, and more. This can help you identify which non-opioid treatments and medications require prior authorization from specific payers, preventing future denials and maximizing reimbursements.
Poor Reimbursement for Non-Opioid Care
Historically, pain management practices have been better reimbursed and incentivized to prescribe opioids rather than other therapies or services to treat a patient’s pain. In some cases, this has been linked to the opioid epidemic, and many patients are now calling on pain management practices to prescribe non-opioid treatment.
To support this push, CMS is offering higher reimbursements from 2025-2027 for certain non-opioid treatments in hospital outpatient and Ambulatory Surgical Center (ASC) settings. As we enter 2025, pain management facilities should consider all non-opioid treatments and services to maximize potential reimbursements for care.
Adonis Intelligence: Maximizing Reimbursements in Pain Management
Adonis Intelligence was built for teams facing reimbursement challenges like these. Intelligence offers AI-driven alerts, comprehensive dashboards and custom reporting, underpayments detection and management, denial trend analysis, payer policy change tracking, and more. Together, these features enable revenue cycle teams at Pain Management organizations to proactively predict and prevent denials, stay on top of prior authorization requirements, and maximize reimbursements for non-opioid care.
With a tool like Adonis Intelligence, revenue cycle teams in Pain Management are maximizing reimbursements, driving speed to cash, and staying on top of the complex and ever-changing regulations that make up billing and coding.
Learn more about the impact that Adonis Intelligence can make at your Pain Management Practice, here.
