Practice Management

Pain physicians are not only highly trained in the many treatment approaches of pain medicine, but are often required to run successful pain businesses. This section offers practical tools and resources for you to use in your pain practice. Coding, policies, patient education and other helpful information will support your daily practice decisions and business needs. This area is also a favorite of office managers and other support staff.

Latest News and Updates

CMS Seeks Comments on Changes to E/M Documentation Guidelines
April 4, 2018 [Source: Emily Hill, PA, AAPM Coding Consultant]
In the November 2017 Final Rule, CMS sought comments on potential updates to the Evaluation and Management (E/M) Documentation Guidelines. CMS indicated it was particularly interested in suggestions for initial changes to the history and exam components. CMS further suggested that medical decision making (MDM) and time are more important factors in distinguishing levels of service.
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Survey: Patient Clinical Outcomes Shortchanged by Prior Authorization
March 21, 2018 [Source: AMA]
More than nine in 10 physicians (92 percent) say that prior authorizations programs have a negative impact on patient clinical outcomes, according to a new physician survey released today by the American Medical Association (AMA).
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New Medicare Card Transition Begins April 1
March 21, 2018 [Source: Emily Hill, PA, AAPM Coding Consultant]
CMS will begin mailing new Medicare cards with the Medicare Beneficiary Identifier (MBI) in April 2018. The MBI on the new card is effective immediately unless the patient is new to Medicare. In that case, the start date will be on the card.
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Diagnostic Errors Top ECRI Institute’s Patient Safety Concerns for 2018
March 12, 2018 [Source: ECRI Institute]
Opioid safety, second on this year's list, stretches across the healthcare continuum. “Opioids are a patient safety concern because of the seriousness of the side effects," says Stephanie Uses, PharmD, MJ, JD, patient safety analyst and consultant, ECRI Institute. "We recommend that clinicians carefully assess patients for opioid use disorder and set realistic expectations about pain."
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Specialty Societies and the AMA Successfully Challenge Anthem Payment Policy
March 7, 2018 [Source: Emily Hill, PA, AAPM Coding Consultant]
In our fast paced world, it sometimes seems there is simply not enough time in a day to get everything done. For the Pain Medicine physician, encountering the patient that needs or demands extensive counseling can seem like a "no-win" situation. There is a way to make time work to your advantage by using time-based coding for some of your patient encounters.
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Targeted Probe and Education (TPE)-New CMS Initiative
February 7, 2018 [Source: Emily Hill, PA, AAPM Coding Consultant]
In October 2017 CMS launched a nationwide program to better target medical review, limit the number of medical records requested, and put an emphasis on education and assistance in correcting claims errors. The goal is to help identified providers and practices by having Medicare Administrative Contractors (MACs) work in person with the practice to identify specific errors and help correct them quickly.
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Bilateral Surgery and Medically Unlikely Edits
January  24, 2018 [Source: Emily Hill, PA, AAPM Coding Consultant]
CMS has released a revised article that addresses the appropriate reporting of bilateral procedures and the potential impact of its rules known as “medically unlikely edits” (MUE) on reimbursement. The revised article provides more examples and details. Bilateral procedures are those that are performed on paired organs or body structures. The use of the bilateral modifier 50 depends on the code descriptor and the bilateral “indicator” assigned by CMS.
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2018 Pain Management Codes Posted on Website
January 10, 2018 [Source: Emily Hill, PA, AAPM Coding Consultant]
The Coding and Reimbursement Committee has updated the coding information available on the AAPM website. New charts have been posted that include information concerning Medicare's 2018 Relative Value Units (RVUs) for codes commonly reported by Pain Medicine Physicians. The title page provides links to CMS web pages that provide additional information and outlines the basis for the 2018 reimbursement rates.
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CPT Changes for 2018
December 20, 2017 [Source: Emily Hill, PA, AAPM Coding Consultant]
Every January 1 sees numerous changes in CPT with varying impact on Pain Medicine physicians. Changes to CPT occur for a variety of reasons. New codes may be the result of innovations or changes in services, the need to more specifically define services for reimbursement purposes or clarification of the CPT descriptor or appropriate use of a code.
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AMA Urges Physicians to Take Steps to Avoid Medicare Payment Penalty
December 13, 2017 [Source: AMA]
The American Medical Association (AMA) is reminding physicians that the Medicare reimbursement system has changed, and, if they have not done so already, they have until December 31, 2017, to take a few simple steps to avoid a Medicare payment penalty in 2019.
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