Do you use Athenahealth for neurology billing every day? Are claim holds slowing down your practice revenue flow? Studies show 40% of neurology claims get held initially. Claim holds cost practices $180,000 each year on average. About 75% of holds are due to missing info. Neurology practices face 3 in 5 claim hold issues. A proper Athenahealth setup can reduce holds by 90% or more.
Athenahealth is a popular cloud-based practice management system today. Neurology billing has complex coding, and the doc always needs it. Claim holds happen when Athenahealth flags issues before submission. Research shows 50% of holds result from incomplete patient data. Many practices waste 30-40% time resolving preventable claim holds. Understanding Athenahealth tools helps prevent most claim-hold problems.
This guide shows proven strategies to reduce neurology claim holds. We cover Athenahealth setup, coding tips, and doc best practices. Learn how to use built-in tools to catch errors early. Improve your practice cash flow starting today with better processes. These methods work for all neurology practices using Athenahealth. Follow these steps to get paid faster and reduce holds.
Set Up Athenahealth Rules Correctly
Athenahealth’s claim rules catch errors before submission. Proper setup prevents the most common claim holds.
Configure Claim Edits
Set up automatic edits for neurology CPT codes. Enable checks for missing diagnosis codes always. Configure time-based coding validation for procedures. Set modifiers to auto-populate when needed. Create alerts for unbundled code combinations. Enable place of service code verification. Proper edits catch 80% of errors early.
Enable Insurance Verification Tools
Turn on automatic eligibility checking for patients. Set verification to run before appointments are scheduled. Enable alerts for expired or inactive coverage. Configure the copay and deductible amount displays. Set up prior OK requirement flags. Enable referral verification when needed.
Customize Documentation Requirements
Set required fields for neurology encounters always. Configure mandatory diagnosis code entry rules. Enable treatment plan documentation prompts when needed. Set alerts for missing procedure notes. Require time documentation for time-based codes. Enable signature requirements for all notes. Missing docs cause 50% of holds.
Use Neurology-Specific CPT Codes Correctly
Wrong codes cause 35% of neurology claim holds. Understanding code requirements prevents hold issues. Athenahealth has tools to help code right.
Common Neurology CPT Codes
EEG codes range from 95812 to 95830. EMG codes start with 95860 through 95887. Nerve conduction studies use 95907 through 95913. Botox injection codes are 64612 through 64617. Infusion codes include 96365 through 96379. Sleep study codes range from 95805 to 95811. Each code has specific doc and time needs.
Code Bundling Rules
Some neurology codes bundle together automatically. Cannot bill nerve conduction with certain EMG codes. Botox supply and admin codes bill separately. Office visit bundles with minor procedures done. Athenahealth shows bundling alerts before submission. Review National Correct Coding Initiative edits regularly.
Modifier Requirements
Modifier 25 shows a significant separate E/M service. Use modifier 59 for distinct procedural services. Modifier 76 indicates repeat procedure same day. Modifier TC bills the technical component only. Modifier 26 bills the professional component separately. Missing modifiers trigger automatic Athenahealth holds.
Complete Documentation in Athenahealth
Poor docs cause 50% of neurology holds. Every encounter needs complete clinical info entered. Athenahealth templates help ensure completeness always.
Use Neurology Templates
Create custom templates for common neurology visits. Include all required fields in templates. Add diagnosis code drop-downs for efficiency. Build procedure code lists specific to neurology. Include time tracking fields for procedures. Add signature fields at the template end. Templates reduce missing info by 70%.
Document Medical Necessity
Enter patient symptoms and exam findings clearly. Include relevant medical history in notes. Document why the procedure was medically needed today. Note previous treatments tried and results. Include risk factors requiring current treatment. Link symptoms directly to diagnosis codes.
Include Time Documentation
Document start and stop times for procedures. Calculate total time spent on service. Include prep and cleanup time when allowed. Only count face-to-face time with the patient. Time must match the CPT code selected. Athenahealth calculates time automatically when entered. Missing time causes code downgrade holds.
Review Claims Before Submission
Athenahealth’s claim scrubber catches errors before sending. Review all holds and alerts daily. Fix issues before claims leave the system.
Check Claim Scrubber Alerts
Open the claim scrubber dashboard every morning. Review all red flag alerts first. Fix high-priority issues before other work. Check yellow warning alerts for problems. Resolve all alerts before releasing claims. Document why alerts are overridden if needed. The clean claims process is 5 times faster.
Verify Patient Demographics
Confirm patient name matches insurance card exactly. Check the date of birth entered correctly. Verify insurance ID numbers are right. Confirm that the subscriber relationship is accurate always. Update address and contact info regularly. Fix demographic errors before claim submission.
Validate Coding Accuracy
Double-check CPT codes match encounter notes. Verify diagnosis codes support the services billed. Confirm modifiers are used appropriately when needed. Check units of service match time. Review the place of service codes carefully. Ensure rendering provider credentials are always up-to-date.
Manage Prior Authorization in Athenahealth
Many neurology services need prior OK always. Athenahealth tracks OK status and expiration dates. Missing OK causes immediate claim holds.
Track Authorization Requirements
Flag services requiring prior OK in the system. Set up alerts for OK expiration dates. Create task reminders for OK renewals needed. Document OK numbers in patient charts. Link OK to specific procedure codes. Enable automatic OK verification checks. Tracking prevents 90% of OK holds.
Submit Authorization Requests
Use Athenahealth to submit OK requests electronically. Include all required clinical docs with the request. Attach procedure codes and diagnosis codes. Add physician notes supporting medical need. Track OK request status in the system. Follow up on pending requests weekly. Electronic submission speeds up approval times.
Monitor Authorization Status
Check the OK status before scheduling procedures always. Update the system when OK is approved or denied. Set expiration date reminders in the calendar. Renew OKs before they expire. Document any OK changes or updates. Keep scanned OK letters in the patient chart. Active monitoring prevents claim holds later.
Use Athenahealth Reporting Tools
Reports identify patterns causing claim holds regularly. Data helps improve billing processes over time. Regular monitoring catches problems early.
Run Hold Analysis Reports
Generate weekly claim hold reports by type. Identify top hold reasons and frequencies. Track holds by the staff member or provider. Monitor the trends over time monthly. Compare hold rates to industry benchmarks. Share reports with the billing team regularly. Data-driven decisions reduce holds by 60%.
Monitor Clean Claim Rates
Track the percentage of claims passing the scrubber the first time. Set goals for clean claim rate improvement. Identify staff needing additional training. Reward high performers with clean submissions. Benchmark against Athenahealth’s average rates shown. Monitor improvement month over month always.
Analyze Denial Patterns
Review denied claims for common issues. Identify if denials started as holds. Track root causes of hold-related denials. Create action plans to prevent recurrence. Train staff on common denial reasons. Monitor if training reduces denial rates. Prevention saves time and money long-term.
Conclusion
Neurology claim holds in Athenahealth hurt practice cash flow. Proper system setup and rules prevent most holds. Correct coding and complete docs reduce hold rates. Prior OK tracking stops authorization holds completely. Regular reporting identifies improvement opportunities quickly. Following these strategies reduces holds by 90% or more. Implement these practices to improve your revenue cycle.
FAQs
What percentage of neurology claims get held?
About 40% of neurology claims face initial holds. Most holds result from missing info or docs. A proper Athenahealth setup reduces hold rates a lot.
How long do claim holds delay payment?
Holds delay claims by 3-7 days on average. Complex holds may take weeks to resolve. Quick resolution improves cash flow significantly faster. Most holds are fixable within 24 hours if caught.
What causes most Athenahealth claim holds?
Missing patient demographics causes many holds. Incomplete docs and coding errors are also common. Prior OK issues trigger automatic system holds.
How do I fix claims on hold?
Open the claim scrubber dashboard in Athenahealth daily. Review red flag alerts and error messages. Fix issues directly in the encounter or claim.
Can I prevent holds with a better setup?
Yes, proper claim rules prevent 80% of holds. Configure edits specific to the neurology codes used. Set required fields for complete documentation always.
