Neurology billing and accounts receivable

Neurology billing runs on far more than the office visit. Ambulatory and long-term video EEG, nerve conduction studies with needle EMG — the pairing most practices simply call EMG/NCS — botulinum toxin for chronic migraine, which every front desk calls Botox, and infused therapies for MS and neuromuscular disease each carry their own authorization path, supervision rule and documentation standard. Each fails in its own way, and almost none of them fails in billing: an authorization obtained for the wrong site of service, a procedure performed in the office and documented but never charged, a drug supplied under the wrong benefit. A denial names the step that reported it, not the step that caused it.

Where the money leaks in neurology

These are the recurring denial reasons in this specialty. They are not exotic. They are the ordinary ones that go unworked because the person who could fix them is at the front desk answering a phone.

• Nerve conduction study with needle EMG denied because the report gives only a summary impression instead of each nerve and muscle tested with its findings
• Botulinum toxin for chronic migraine denied because the chart records migraine without the headache-day frequency or the preventive medications already tried and failed
• Long-term video EEG authorized as an ambulatory home recording but performed as an admission to the epilepsy monitoring unit, so the facility days sit outside the authorization
• EEG interpreted by the practice but recorded on hospital equipment and billed globally, so the technical component collides with the facility's own claim
• Infusion drug shipped to the practice under the plan's pharmacy benefit but billed as practice-purchased stock, so the drug line is rejected and only the administration survives
• Infused or injectable neurology drug denied under step therapy because the earlier drug trial and its failure never reached the authorization packet
• In-office procedure performed and documented in the note but never raised as a charge, so no claim exists, no denial is generated, and nothing in any report shows the money was lost

What a seat does about it

One trained person works your queue from the difficult end, from our office in Rawalpindi, Pakistan, logged into your own system on your hours. Every call is logged with the payer reference number and the outcome, so an appeal can quote what was said rather than start again. Denials are categorised, which is how the same reason stops coming back next month. On Friday you get it in writing. Some payer contracts and some state Medicaid programs restrict or require disclosure of offshore access — check yours before placing a restricted queue on this seat (more on /security/).

The roles that matter most in this specialty are AR calling and denials at $1,700, prior authorization at $1,900, and medical coding at $2,500, on request.

The codes those turn into

Each of these is a denial code you are likely to meet working neurology, matched to the problem above it in your own words. The route back to payment differs by code, so a queue sorted by recovery route clears faster than one sorted by date.

• CO-198 — Authorization limit exceeded
  An authorization exists. The problem is that you went past what it allowed — more units, more visits, or a longer date range than was approved.
  Recovered by being taken back to the authorization. Matched from: “Long-term video EEG authorized as an ambulatory home recording but performed as an admission to the epilepsy monitoring unit, so the facility days sit outside the authorization”

Working a denied claim costs $57.23 per denied claim in administrative time (source), and payers ultimately pay roughly 90% of claims even while using an initial denial to slow payment. Most of what sits in a neurology AR bucket is not lost money. It is money waiting for somebody with the hours to make the call.

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