• Neurology practices constantly face the burden of meeting Medicare requirements. LCDs and NCDs are complex, frequency limitations are strict, and documentation of medical necessity is exhaustive.
• Even a small oversight can lead to denials. Practices must also maintain HIPAA compliance when transmitting EEG data, handling sleep study results, and coordinating care.
• The pressure is heightened by quality reporting requirements under MIPS (Merit-based Incentive Payment System), the Quality Payment Program, and neurology-specific registries, which demand ongoing attention and resources.

• Prior authorization is one of the biggest hurdles. Each payer has its own requirements, and delays or denials are frequent. Urgent cases become even harder to manage in-house.
• Claims processing is another constant challenge; clean submissions, payer-specific rules, denial workflows, and appeals all require specialized systems.
• Patient financial responsibility adds further complexity, as high deductibles, costly neurology procedures, and frequent coverage limitations make it difficult for practices to secure timely payments.
• On top of this, neurology billing is highly vulnerable to fraud and abuse risks, from upcoding and inappropriate diagnostic billing to modifier misuse and missing documentation.

• Neurology billing relies heavily on the proper use of modifiers, to avoid bundling, define services correctly, and stay compliant.
• Misuse or omission of even one can result in lost revenue or audit exposure.

• Neurology coding is notoriously complex. ICD-10-CM requires pinpoint accuracy, capturing laterality, severity, stage of disease, and multiple manifestations all at once.
• A single mistake can trigger denials, audits, or compliance risks.

Neurological billing demands detailed documentation to prove medical necessity. Be sure to include:

• Comprehensive neurological exams with specific findings
• Mental status and cognitive testing results
• Seizure frequency logs and medication response tracking
• Progressive disease staging and functional assessments

Managing this level of documentation in-house is time-consuming and prone to errors, putting practices at risk for audits and denials.

Many neurological procedures have global periods that affect billing:

• Minor procedures typically have 0-10-day global periods
• Major procedures may have 90-day global periods

Failing to apply these rules correctly almost always leads to denied claims or compliance violations.

The Medicare Correct Coding Initiative (NCCI) edits significantly impact neurology billing:

• Nerve conduction studies and EMG have specific bundling rules
• EEG interpretation cannot be billed separately from the technical component in certain circumstances
• Sleep studies have complex bundling requirements

They create constant medical billing risk for errors when managed in-house and without expert support.

High-cost neurological procedures require careful pre-authorization:

• Advanced imaging (MRI, PET scans)
• Expensive medications and infusion therapies
• Neurostimulator implants and programming
• Specialized diagnostic testing

In-house teams often struggle to keep up with the payer-specific rules, approval timelines, and urgent cases, leading to delays and denials.

Ongoing care for chronic neurological conditions introduces unique billing hurdles:

• Multiple Sclerosis: Tracking disease-modifying therapy and monitoring outcomes
• Epilepsy: Recording medication adjustments, seizure logs, and device monitoring
• Parkinson’s Disease: Documenting motor fluctuations and treatment modifications
• Dementia: Performing cognitive assessments and caregiver counseling

These long-term care requirements make billing highly specialized and difficult to manage internally.

Modern neurology practices use sophisticated equipment requiring specialized billing knowledge:

• EEG machine integration and interpretation billing
• Sleep lab equipment and study coordination
• Neurostimulator programming software
• Telemedicine platforms for remote monitoring

At Health & Billing, we specialize in neurology billing and complete RCM revenue cycle management solutions. We can professionally help practices like yours to overcome these hurdles and improve your financial performance.