The human nervous system is a complex web of neurons, synapses, and signals that control every aspect of our bodies. Neurology medical billing is the process in which neurologists create charges for the services they provide and file payment claims to insurance companies for reimbursement. It is an essential part of a neurology practice’s revenue cycle, as successful billing plays a huge role in a business’s financial health.
Just as the intricacies of the nervous system can lead to challenging diagnoses and treatments for neurologists, so too can neurology medical billing become a complicated process. So let’s explore the neurology medical billing process, challenges to neurology billing, and tips to streamline the process.
Neurology Medical Billing Guidelines
The goal of medical billing in neurology is to ensure providers get paid appropriately for their services. But in order to define what is appropriate, providers must first quantify their work—not an easy task for such a complex medical specialty as neurology.
Evaluation and Management & Medical Decision Making
Two systems form the basis for helping providers determine the level of care they have provided: Evaluation and Management (E/M) and Medical Decision Making (MDM). E/M coding considers the extent of the history, examination, and medical decision-making involved in a patient encounter, while MDM focuses on the complexity of the decision-making process. Both are used to determine the appropriate level of reimbursement for the services provided by neurologists, based on the complexity and amount of work required.
E/M services are categorized into levels of service based on the complexity of the service provided, ranging from Level 1 (minimal) to Level 5 (complex). Similarly, MDM has four categories: straightforward, low complexity, moderate complexity, and high complexity.
Once these levels are determined, billers then translate each procedure or service into industry-recognized alphanumeric codes. The two main code sets used by medical providers are the Current Procedural Terminology (CPT) and the International Classification of Diseases, Tenth Revision (ICD-10). The ICD-10 has two subsets, the Procedural Coding System (ICD-10-PCS) used primarily in inpatient and hospital settings and the Clinically Modified (ICD-10-CM) code set for clinical and outpatient settings.
Examples of Neurology CPT & ICD Codes
Each of these code sets have subsets for neurology. The CPT code range for neurology and neuromuscular procedures is 95700-96020. Below are a few examples of categories:
- Electromyography procedures 95860—95872
- Routine EEG procedures 95812—95836
- Nerve conduction tests 95905—95913
As for ICD-10, codes for diseases of the nervous system range from G00—G99. Below are a few examples. Note how the difference of a single digit significantly changes the diagnosis.
- Alzheimer’s disease with early onset G30.0
- Alzheimer’s disease with late onset G30.1
- Other Alzheimer’s disease G30.8
- Sleep apnea, unspecified G47.30
- Primary central sleep apnea G47.31
- Obstructive sleep apnea (adult) (pediatric) G47.33
Neurology Revenue Cycle Management Steps
Step 1: Pre-Authorization and Insurance Eligibility Verification
Before providing any services to patients, it is important to verify their insurance coverage and eligibility. Coverage for neurology procedures can vary depending on the patient’s insurance plan and often come with terms and conditions. This can help determine if the patient is responsible for any out-of-pocket expenses, and if so, how much. Accurate verification can help reduce the risk of denied claims and ensure that services are reimbursed in a timely manner.
Step 2: Rendering Neurology Services and Capturing Charges
The second step in neurology revenue cycle management is rendering services and capturing charges. It is critical for providers to document every aspect of the patient visit, including their decision making process, any diagnostic tests or procedures performed, and the amount of time spent with the patient. These details are documented as E/M levels and MDM, which later serve as verification of services rendered. Capturing charges in this way helps ensure the correct amount is billed to the patient’s insurance company.
Step 3: Neurology Claims Submission
After all charges are captured, the patient’s medical documentation is translated into industry-recognized CPT and ICD-10 codes, usually by a specialized medical coder. Neurology medical billers then itemize these codes in a payment claim and submit the claim to the patient’s insurance provider. In many cases, a single patient visit will result in multiple, separate claims that may go to various payers.
Step 4: Payment
The fourth step in neurology revenue cycle management is payment. After claims have been submitted, the insurance company will review and process the claims. Payment will be issued for approved claims, and any denied claims will need to be appealed or resubmitted.
Billers also send invoices to patients for remaining balances after insurance payouts. In the case of late or unfulfilled payments, medical billers are responsible for reaching out to patients regarding payment collection. For this aspect of the billing process, staff members need to be familiar with insurance plans’ Explanation of Benefits to explain charges to patients.
Step 5: Data Reporting
Reporting is an important aspect of neurology medical billing, as it helps to track the financial health of the practice. This step involves generating reports that provide valuable insights into the financial health of their business. Regular review of these reports allows providers to identify areas for improvement and make informed decisions about the future of the practice. Some regulatory agencies also require that providers submit data to verify quality of treatment and compliance.
Challenges for Neurology Medical Billing
Misunderstanding Neurology Codes
Because the diagnoses and treatments for neurological conditions are so nuanced, even experienced medical billing professionals can make mistakes when coding. Using incorrect medical codes can result in rejected claims or delays in payment.
Sometimes, the same symptom can be codified in different ways based on diagnosis. G25.0 is the ICD-10 diagnosis code for essential tremor, a neurological disorder characterized by involuntary and rhythmic shaking of the hands, head, or other parts of the body. If a provider is not specific in their report or a medical biller misinterprets patient records, the tremor might get the diagnosis code R25.1 instead, which is “tremor, unspecified.” Such small distinctions can result in denied claims by insurance companies down the line, ultimately resulting in lost income.
Adding Time-Consuming Tasks to Neurology Billing Processes
Neurology medical billers may process hundreds of claims a day. Billing processes can become time-consuming, with staff spending hours on manual data entry and claims submission. This can result in delays in payment and increased costs for the practice.
Completing such a large volume of paperwork by hand can often result in erroneous code assignments—even a mistyped digit in an online form—that lead to claims denials. And billers often file multiple claims for a single patient visit, so these errors can have a knock-on effect for unfulfilled payments.
Tips for Streamlining Neurology Medical Billing
Verify Insurance Coverage
Before treating patients, practitioners should check whether the patient’s insurance company will cover the cost of the services provided. Neurology procedures vary greatly, and each insurance plan has its own set of rules for coverage. Some plans cover certain procedures but not others, while others cover certain procedures conditionally. Verifying coverage in advance reduces the risk of denied claims and ensures that services are reimbursed in a timely manner.
Keep Accurate Documentation
It is critical for neurology providers to maintain comprehensive records of every patient visit, including keeping track of all diagnosis codes, CPT codes, and modifiers. Accurate and complete documentation support the medical decision-making process and provide evidence of the medical necessity of the procedures being billed to payers. These details help ensure that providers are reimbursed appropriately for the treatment they provide and reduce the risk of denied claims or audits.
Submit Claims on Time
Claims should be submitted as soon as possible to avoid any delays in payment. Some insurance companies have filing deadlines that, when missed, nullify coverage. Neurology billers need to stay on top of these deadlines to prevent unnecessary revenue loss.
Stay Up to Date with Regulations
The medical billing landscape is constantly changing, with new regulations and policies being introduced regularly. It is important to stay up-to-date with these changes and make sure your billing practices are compliant.
Use Medical Billing Technology
There are many technology tools available that can help streamline the medical billing process, from electronic health record (EHR) systems to medical billing software. Neurologists can also consider integrated digital charge capture solutions, which assign codes to help eliminate lost or missed charges and share patient information. This can save time and improve the accuracy of the billing process.
Hire a Professional Medical Billing Service Provider
If you find it difficult to manage your neurology billing in-house, consider hiring a professional medical coding and billing company. This can save you time and resources, while ensuring that your billing is accurate and compliant with regulations.
Neurology Medical Billing Software
Too many neurology providers still file and track payment claims manually, which makes a practice susceptible to problems caused by human error. The best medical billing software solutions streamline workflows with features such as automated medical coding, electronic claims submission, automated patient eligibility verification, and integration with electronic health record (EHR) and electronic medical record (EMR) systems.
CollaborateMD is a flexible, scalable solution that streamlines the neurology medical billing process to optimize revenue, while giving your staff time and resources back to focus on quality patient care.
Learn more about how CollaborateMD’s medical billing software can improve efficiency and accuracy in the neurology billing process. To see what makes our platform the choice of thousands of practices in our 20+ years of business, schedule your demo today!
