What No One Tells You About Neurology Claim Denials Neurology is one of those specialties where the medicine is complicated, but honestly, the billing might be even harder. Denied claims are simply part of the job, if you run a neurology clinic or are involved in your billing office. However, this is a detail no one is discussing – most denials by neurologists are not arbitrary. They repeat a pattern and if you see the pattern, you can actually stop them. Denials Aren't Bad Luck, They're a Pattern Most people think that claim denials are a random occurrence, a thing that simply happens every now and again, like a coin flip. No, that's not the case in neurology. Some of the highest denials in all of medicine are in this specialty, and not necessarily because neurologists are doing something wrong clinically. It's because the billing side is actually quite complicated. Other services are subject to the same billing staff specificity requirements as EEGs, EMGs, nerve conduction studies, and Botox for migraines. The Diagnosis Code Problem This is a thing that many practices will be surprised about. Denial doesn't equal no need for a test. It usually indicates that the diagnosis code on the claim was too generic. The payer is not going to feel that a headache or dizziness is an appropriate reason for a detailed EEG study; therefore, it will almost always be denied if it's written on a claim. The solution, in theory, is simple: be more specific with the code, but in a hectic clinic, not so easy. The Modifier Mistake That Costs Real Money Other subtle issues include modifiers. There are sometimes two parts to neurological testing: the technical part (where the machine is run) and the professional part (where a doctor analyzes the results). When the billing team confuses these or forgets to split them appropriately, it results in claims being denied or overpaid. This one little error can result in losing a lot of money for a mid-sized practice without anyone realizing it immediately, on an annual basis. Why Denied Claims Often Just Disappear The stingers are here. Many of the claims that are denied don't go on appeal. They are simply written off. Not because it was an incorrect statement, but because no one had the time to challenge it. Denials are not easy to appeal, require a paper chase, and require follow-up, and busy neurology practices may not have a follow up person. So, the money simply vanishes from the practice's revenue each month. What Actually Helps Fortunately, there is a real solution to the problem. It's typically a matter of having someone with a great deal of knowledge about neurology billing, rather than just medical billing. This is the reason so many practices are opting for neurology billing companies rather than general in-house billing teams. A neurological team understands the codes to support the tests, the proper application of modifiers in the split, and early identification of denials rather than a ton. In the end, neurology claim denials aren't a magic bullet. The result is predictable, given that a complex billing system is coupled with a busy clinical schedule. If a practice knows where the problems typically occur, then fixing them is not so difficult as one might think. All it requires is the right attention at the right place.