As physicians are taking into consideration the use of medical billing services to stop the hemorrhaging of cash from their practices, they are faced with a broad range of options. On the diminutive end of the spectrum are home-based medical billers. On the opposite end of the spectrum are medical billing companies that employ hundreds of medical billers and have thousands of clients.

Medical billing is a highly complex area and it requires experience-based knowledge and expertise to contend with insurance companies. When it comes to neurology billing, the situation gets even more complex. Such complexity can be handled only by a company that is staffed with well trained neurology billing professionals. The medical billing specialist must be familiar with the specific codes and rules that make up the world of neurology billing.

As the cost of providing neurology related healthcare services continues to rise, medical institutions and neurology practices cannot afford to leave revenue uncollected by medical billing companies or freelancers that are not knowledgeable in neurology billing. It is also important to keep in mind some billing companies may promote themselves as large neurology billing service providers but in reality they sub-contract the neurology billing to freelancers who work from home. Hiring such companies will lead to lost revenue because of the lack of proper process, controls, and training.

Deep familiarity and comfort with neurology procedures and terminology does not come from serving one or two neurologists. Neurology billing success requires both broad and deep expertise in order to collect all of the money owed the neurologist and successfully appeal claims which have been denied or answer questions the payers may have about a claim.

A typical shortcoming with medical billing services that do not specialize in neurology billing is the inability to properly track and pursue insurance underpayments. These underpayments cost most neurologists about 10% of their potential income.

The neurology-driven difficulties of medical billing encompass patient billing also. A neurologist’s patient balance process is more challenging because most of the difficulties of explaining to a patient their complicated Explanation Of Benefits and the neurology terminology on their bills. This drives the need for patient collection specialists that have a strong expertise in neurology billing.  If patients are not handled with care then neurologists will see their patient collections fall and their patient complains rise – not a good combination.

Denied claims

Once a procedure has been performed and a claim submitted, payers often deny coverage of that item, but often the claim is legitimate and a coding error has been included that does not correctly indicate what was done. One common reason for this is that the coding for the tests that demonstrated that the procedure was medically necessary are missing. It doesn’t matter if the rest of the documentation makes it obvious that it was necessary, the coding requirements must be followed, literally, to the letter.

Global surgery packages

The idea behind global surgery packages is tosimplify medical billing by eliminating the need to add a detailed code for eachpart of a surgery and any related care; however, not every surgery fits thepackage and billers must recognize anything that is not included and bill for itappropriately, which usually includes modifiers to demonstrate medical necessity.A single surgery claim can be for a very large amount, so it is important thatevery single claim is properly reimbursed.

Underbilling due to omitting services

Surgery is complicated and requires the participation of many people, some of whom may be employed by a different entity. It is easy to miss the services provided by one or more of them, which can result in large amounts of lost revenue. Over time, the cumulative effect can be significant enough to threaten the solvency of the practice.