Solving Pain Management Billing Challenges

The Revenue Cycle Challenges Facing Pain Management Groups

And What to Do About Them

Pain management groups play a vital role in treating patients with chronic and acute pain using a combination of interventional procedures, physical therapy, medication management, and advanced diagnostics. But while these groups focus on delivering relief and restoring quality of life, many are increasingly burdened by the complexity and inherent challenges of their revenue cycle operations.

At the heart of the issue is a perfect storm of diverse payer types, evolving billing rules, and administrative strain, all of which put pressure on practice’s ability to thrive. Let’s review some of these challenges and consider ways to manage them more effectively, now and in the future.

A Complex Reimbursement Landscape

Unlike many other specialties, pain management groups often operate across three very different reimbursement models:

• Commercial Insurance: While these plans offer relatively stable reimbursement rates, they often come with strict documentation requirements, procedure authorizations, and narrow networks.

Prior-authorization processes are often more extensive and have extra steps – for example, demonstrating that an injury was not employment or accident-related. Without wire-tight internal processes and adequate (and experienced) staff, denials and subsequent appeals – particularly for interventional procedures – are common and time-consuming.

•Worker’s Compensation (WC): Pain groups treating WC patients must navigate jurisdiction-specific fee schedules, slow authorization processes, and intensive reporting requirements. Payments are often delayed or partial, especially when adjusters contest medical necessity or claim liability. In addition, WC fee schedules can reduce practice margins and the complexities of their processes – seemingly designed by the proverbial Rube Goldberg, make chasing every dollar due can create significant burdens on RCM staff.

• Litigation-Based (Personal Injury/Lien) Cases: These high-risk, high-potential claims by their very nature introduce significant cash flow uncertainty. Providers may wait months—or years—for settlements, with no guarantee of payment. Legal intermediaries, inconsistent documentation, and lien negotiation further complicate collections. The documentation burden over these extensive cases introduce risk throughout and make capturing every nuance of the patient’s journey essential.

Each of these revenue sources comes with its own billing and follow-up protocols. Managing them in parallel requires a highly coordinated, specialized revenue cycle strategy – something that many practices are not fully resourced to support internally.

Common RCM Challenges in Pain Management

Here are just a few of the most pressing revenue cycle obstacles pain groups are faced with on a daily basis:

Challenge	Impact
Authorization Delays	Procedures delayed, revenue disrupted
Denials from Incomplete Documentation	Lost revenue, staff burden for rework
Unpredictable PI/Legal Collections	Strains cash flow, creates write-offs
State-Specific WC Rules	Inconsistent reimbursement and appeal processes
Overwhelmed Billing Staff	Burnout, errors, and turnover
Lack of Specialty-Specific RCM Expertise	Lower net collections and longer AR cycles

A Strategic RCM Approach for Successful Pain Practices

To succeed in today’s environment, pain groups must shift from transactional billing to strategic revenue cycle management. This includes:

• Proactive Authorization Management – avoiding denials before they happen

• Custom Workflows for WC and PI Claims – not just coding, but end-to-end life cycle management

• Analytics-Driven AR Follow-Up – targeting accounts that are most collectible, ensuring a ‘fastest to cash’ outcome

• Litigation & Lien Support – including legal coordination, document tracking, and negotiation

• Credentialing & Payer Strategy – ensuring access to in-network benefits and minimizing out-of-network denials

These are the types of solutions Fedora Healthcare Solutions was built to deliver.

How Fedora Healthcare Solutions Helps

Fedora Healthcare Solutions specializes in revenue cycle management for pain management groups. Our services are designed to align with the unique demands of the specialty—from commercial payers to worker’s comp to PI/litigation-based claims.

• Our Specialized Approach to RCM for Pain Groups Reaps Dividends

• Dedicated teams with deep WC and PI, state-specific expertise

• Careful and thorough authorization tracking and appeals management

• Full transparency through detailed reporting dashboards

• Legal liaison services for litigation-based claims

• Onboarding support and cleanup of legacy AR

• Ability to work with any EMR/PM system, WC environment and PI cycle

We don’t just process claims – we actively drive reimbursement and partner with your practice for long-term success.

Final Thoughts: You Don’t Have to Do This Alone

The financial future of pain management practices depends on mastering the complexities of billing across multiple payer types without losing focus on patient care. That’s where Fedora Healthcare Solutions comes in.

If you’re struggling with denials, slow PI payments, or just want a second opinion on how your billing operations could improve, we’d love to talk. Contact us