Case Study: Neurology Practice Claimed $389K and Reduced Denials by 54%
Billing for neurology services is complex—procedures are detailed, coding is technical, and payer rules are constantly changing. A neurology clinic in Rochester was dealing with these challenges on a daily basis. Despite a steady flow of services, their revenue performance was falling short due to frequent denials, underpayments, and delayed reimbursements.
By partnering with MBW RCM, the clinic revamped its billing operations. In just six months, they recovered $389,000 in missed revenue, reduced denials from 24% to 11%, and shortened payment cycles by 22 days—a major improvement to their financial stability.
Client Overview
Location: Rochester, Minnesota, USA
Specialty: Neurology billing Services
Monthly Patient Volume: 850+
Monthly Revenue Volume: $600,000
Average Monthly Collections (Before): $400,000
Like many neurology practices, they were facing challenges with coding precision, timely follow-up, and payer policy complexity.
Key Challenges in Neurology Medical Billing
Neuro diagnostic Test Bundling Errors
Tests like EEGs, EMGs, and nerve conduction studies often involve bundled codes. Incorrect bundling can lead to rejection for unbundled services or inappropriate duplicate billing.
ICD-10 Specificity in Neurological Disorders
Conditions such as epilepsy, multiple sclerosis, or neuropathies require precise subcategory codes (e.g., G40.901). Generalized codes may result in claim denial or audit flags.
Billing for Tele-Neurology and Remote Services
Virtual neurology visits require modifiers (e.g., 95, GT) and documented patient consent. Missteps in telehealth coding lead to claim denials or improper billing.
Cognitive Assessment and Neuropsychology Billing
Services like Montreal Cognitive Assessment (CPT 96132/96133) are frequently under-billed or misclassified due to confusion around complexity levels or time-based components.
Chronic Care Management (CCM) Oversights
Monthly billing for CCM (e.g., CPT 99490) requires detailed time logs and patient consent. Lack of proper documentation can result in lost recurring revenue.
Our Neurology Billing Approach
MBW conducted a full audit of the clinic’s neurology revenue cycle and implemented a series of targeted improvements:
| Challenge | What We Did |
|---|---|
| Neurodiagnostic Test Bundling Errors | Audited 6 months of EMG, EEG, and NCS claims and found 22% incorrectly bundled. Corrective action on coding and modifier usage recovered over $96,000 in missed revenue and reduced bundling-related rejections by 40%. |
| ICD-10 Specificity in Neurological Disorders | Improved diagnostic coding specificity for epilepsy, MS, and neuropathy claims. By flagging and correcting generic codes (e.g., G40.909), we decreased coding-related denials by 54% and helped recover $72,000 from previously rejected claims. |
| Billing for Tele-Neurology and Remote Services | Standardized use of modifiers (95, GT) and documented virtual consent workflows. This increased telehealth claim approval rates from 82% to 97%, capturing an additional $58,000 in accepted reimbursements for remote services. |
| Cognitive Assessment and Neuropsychology Billing | Identified 38% of cognitive assessment sessions were undercoded (e.g., CPT 96132). Introduced templated billing workflows that improved compliance and added $84,000 in additional revenue within six months. |
| Chronic Care Management (CCM) Oversights | Activated a structured CCM billing process using CPT 99490. Tracked care coordination time and ensured documentation and consent compliance—resulting in $79,000 in new recurring revenue across eligible patients. |
Results After 6 Months
Claim denials dropped from 24% to 11%
$389,000 in recovered revenue
Payment turnaround improved from 65 days to 43 days
98% of claims accepted on first submission
Authorization-related denials reduced from 20% to 5%
Neurology coding errors dropped by 70%
Conclusion
At MBW RCM, we focus on solving the real challenges neurology practices face every day. By improving code compliance, reducing denials, and speeding up reimbursements, we helped this Rochester clinic recover revenue and gain stronger control over its billing process.
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