Do you use Athenahealth for pain management billing? Are claim denials affecting your practice revenue stream? Pain management billing has a 25% denial rate nationally. Athenahealth users report 15% fewer denials with proper setup. Studies show 68% of pain practices lose revenue from coding errors. Proper system configuration can improve collections by 30%.
Pain management billing involves complex codes and strict rules. Injection codes, nerve blocks, and trigger points need special attention. Insurance companies review pain management claims very closely. Documentation requirements are stricter for controlled substance prescriptions and procedures. Research shows 45% of pain management denials stem from poor documentation.
This guide covers Athenahealth’s best practices for pain management. We show how to set up your system correctly. Learn templates, workflows, and automation features that work. Improve your practice revenue with better billing processes today. These tips help reduce denials and speed up payments. Follow these guidelines to maximize your Athenahealth investment fully.
Setting Up Athenahealth for Pain Management
Proper system setup prevents most billing errors. Configure Athenahealth for pain management needs.
Customizing Fee Schedules
Enter all pain management CPT codes used. Set up different fee schedules by payer. Include injection codes 20550 through 20553. Add nerve block codes 64400 through 64530. Include trigger point codes and modifiers. Update fees when Medicare rates change. Check commercial payer fee schedules quarterly.
Creating Custom Templates
Build templates for common pain procedures. Include all needed doc fields automatically. Set up templates for epidural injections. Create forms for facet joint injections. Add templates for trigger point injections. Include body diagrams in templates. Templates ensure consistent, complete docs always.
Configuring Charge Capture
Set up charge capture for procedure rooms. Create quick-pick lists for common procedures. Link procedures to needed docs automatically. Enable automatic coding suggestions based on notes. Set alerts for missing needed fields. Set up charge review workflows for accuracy. Proper setup reduces missed charges a lot.
Documentation Best Practices
Good docs support every claim submitted well. Athenahealth templates help ensure completeness always.
Procedure Documentation Requirements
Document the medical need for every procedure clearly. Include patient symptoms and pain levels. Record previous treatments tried and failed. Note physical exam findings supporting the procedure. Include imaging results when applicable, always. Document-informed consent was obtained properly.
Time-Based Documentation
Record start and stop times correctly. Calculate the total procedure time spent correctly. Include pre-procedure and post-procedure time. Document moderate sedation time separately when used. Time must match the codes billed exactly. Use Athenahealth time stamps for accuracy.
Template Utilization Tips
Use structured templates for all procedures. Fill in all needed fields completely. Avoid cutting and pasting old notes. Customize templates for different procedure types. Include body diagrams for injection sites. Add check boxes for common elements. Review completed notes before signing always.
Coding Pain Management Procedures
Pain management uses hundreds of specific codes. Wrong codes cause most claim denials. Understanding coding rules prevents billing errors.
Injection and Nerve Block Codes
Code 20550 is a single-tendon injection. Code 20551 is a single-tendon sheath injection. Code 20552 is a single trigger point injection. Code 20553 is multiple trigger point injections. Nerve blocks use codes 64400 through 64530. Each nerve has specific code needs. Document exact injection sites and levels.
Modifier Requirements
Modifier 50 shows bilateral procedures performed. Modifier 59 shows distinct, separate procedures. Modifier 76 shows repeat procedure same day. Modifier 77 shows repeat by a different physician. Modifier RT shows the right side procedure. Modifier LT showsthe left side procedure.
Billing Multiple Procedures
List the highest paying procedure first, always. Use modifier 51 for multiple procedures. Apply multiple procedure payment reduction rules. Check payer policies for bundling edits. Some codes cannot be billed together. Use append modifiers to unbundle when right. Athenahealth flags potential bundling issues automatically.
Insurance Verification and Authorization
Check coverage before every procedure scheduled. Prior authorization prevents denials and payment delays.
Eligibility Verification Process
Check eligibility before appointment in Athenahealth. Check active coverage and benefits status. Review copay and deductible amounts owed. Check if prior auth is needed. Confirm the provider is in-network with the plan. Update insurance info at each visit. Document verification in the patient chart is always.
Prior Authorization Management
Submit auth requests through the Athenahealth portal. Include clinical docs supporting medical need. Attach imaging reports and previous treatment records. Track auth status in the system dashboard. Set reminders for auth expiration dates. Renew auths before they expire completely.
Benefits Verification
Check pain management coverage limits and caps. Check injection frequency limits per year. Review visit limits for therapy sessions. Confirm controlled substance coverage and restrictions. Check if step therapy needs exist. Document all benefit details in notes. Missing verification leads to denied claims.
Claim Submission and Follow-Up
Submit clean claims the first time. Athenahealth automation speeds up claim processing. Good follow-up improves collection rates a lot.
Clean Claim Submission
Run the claim scrubber before submitting claims. Fix all errors flagged by the system. Check that the codes match the docs provided exactly. Check that the modifier usage is right. Confirm patient demographics are right and current. Attach any needed docs to claims. Submit claims within 24 hours of service.
Denial Management Workflow
Review denials daily in the Athenahealth dashboard. Categorize denials by reason code type. Appeal denials with additional docs promptly. Resubmit corrected claims within the timeframe allowed. Track denial trends and patterns monthly. Identify root causes of common denials.
Payment Posting Automation
Enable automatic payment posting in the system. Review posted payments for accuracy daily. Research payment variances and underpayments quickly. Appeal short payments with supporting docs. Post patient payments at the time of service. Reconcile daily deposits with posted payments.
Reporting and Analytics
Use Athenahealth reports to monitor performance. Track key metrics to improve revenue. Data helps identify problems and opportunities.
Key Performance Indicators
Monitor days in accounts receivable closely. Track claim denial rate by payer. Review the net collection rate monthly trends. Measure clean claim rate percentages consistently. Track auth approval and denial rates. Monitor charge lag time from service. Set benchmarks and goals for improvement.
Custom Report Creation
Build reports for pain-specific procedures. Track injection volume by type and payer. Monitor modifier usage and denial patterns. Review provider productivity and billing metrics. Analyze payer mix and reimbursement rates. Create reports for compliance monitoring needs. Run reports monthly to identify trends.
Dashboard Utilization
Use provider dashboards for daily metrics. Monitor open encounters needing completion urgently. Track unsigned notes needing the provider’s signature. Review pending claims awaiting submission to payers. Check auth requests needing follow-up action. Monitor aging accounts receivable by time period.
Conclusion
Athenahealth offers powerful tools for pain management billing. Proper setup and configuration prevent the most common errors. Templates ensure complete docs supporting every claim. Good verification and auth processes reduce denials. Automated workflows speed up claim submission and payment. Regular reporting helps identify and fix problems.
FAQs
How do I set up pain management templates in Athenahealth?
Go to Settings and select Clinical Templates. Create a new template for each procedure type. Include all needed doc fields automatically.
What reports help track pain management billing?
Run denial rate reports by procedure type. Check days in AR reports monthly. Review clean claim rate percentages regularly. Monitor net collection rate trends over time.
How does Athenahealth help with prior authorizations?
System automates the auth request submission process. Tracks auth status in real-time dashboards. Sends alerts for expiring auths automatically.
Can Athenahealth prevent coding errors automatically?
Yes, the system has built-in coding edits. Flags potential bundling issues before submission. Suggests codes based on the docs entered.
How often should I update fee schedules?
Update Medicare fees annually in January. Review commercial payer contracts quarterly at a minimum. Update when receiving new fee schedules. Check rates match contracted amounts always.
What is the average denial rate for pain management?
The national average is 25% for pain practices. Athenahealth users report 15% denial rates. Proper setup reduces denials a lot lower.
