Neurology

Introduction

This case study highlights how a busy neurology clinic partnered with a medical billing company to optimize its revenue cycle management. The engagement led to improved billing accuracy, reduced denial rates, faster payments, and increased revenue—without disrupting clinical operations.

Background

This case study highlights how a busy neurology clinic partnered with a medical billing company to optimize its revenue cycle management. The engagement led to improved billing accuracy, reduced denial rates, faster payments, and increased revenue—without disrupting clinical operations.

Revenue Cycle Challenges

• Complex Coding Requirements: Neurology services like EEG, EMG, Botox for migraines, and long-term video monitoring involve highly specific codes that were often miscoded or under-coded.
• Authorization Delays: Time-consuming pre-authorizations for imaging, injectables, and diagnostic studies led to delays and rescheduling.
• High Denial Rates: Payers denied claims for reasons including missing documentation, non-covered services, and lack of medical necessity.
• Inadequate Claim Follow-Up: The in-house team lacked the bandwidth for consistent follow-up on aging and underpaid claims.

Objectives

• Improve Coding Accuracy: Ensure proper documentation and coding of neurology procedures to maximize reimbursement.
• Reduce Denials: Identify and correct patterns leading to claim rejections and denials.
• Speed Up Prior Authorizations: Streamline the pre-auth process to reduce appointment delays.
• Strengthen A/R Follow-Up: Enhance follow-up on aging claims to recover outstanding revenue.

Intervention

The medical billing company implemented the following interventions:

• Specialty-Specific Coding Support: Provided certified coders trained in neurology-specific CPT and ICD-10 codes.
• Pre-Authorization Workflow: Deployed a dedicated pre-auth team using payer portals and automated workflows integrated with Athenahealth.
• Denial Analytics Dashboard: Created real-time dashboards to monitor denial trends and proactively resolve issues.
• Dedicated A/R Team: Assigned a focused team to work on unpaid and underpaid claims to reduce aging A/R.

Results

Conclusion

By outsourcing billing to a specialized medical billing company, the neurology clinic dramatically improved its coding compliance, reduced claim denials, and accelerated payment timelines. This partnership empowered the clinic to focus on delivering advanced neurological care while achieving consistent financial growth.