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Showing posts with the label Neurology Claims Facing More Documentation Audits

How OBGYN Practices Can Prepare for the 2027 Maternity Billing Changes

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The 2027 maternity billing changes will significantly alter how OBGYN practices report maternity care. Beginning January 1, 2027 , the CPT maternity care structure will move away from the traditional global model toward more detailed reporting across four phases: antepartum care, labor management, delivery, and postpartum care . The American Medical Association (AMA) has confirmed that 17 existing codes will be deleted, 12 new codes will be added, and six codes will be revised. For OBGYN practices, this is not simply a coding update. It can affect documentation, EHR workflows, charge capture, claims submission, payer contracts, reimbursement, AR, and denial management. Practices that begin preparing now will have more time to test their systems, train staff, review payer requirements, and identify potential revenue risks. For a broader explanation of the upcoming changes, see What Is the 2027 Maternity Billing Change and How Should OBGYN Practices Prepare? . Understand What Is Chan...

Why Are Neurology Claims Facing More Documentation Audits from Payers?

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Neurology claims are facing more documentation audits because payers are tightening compliance oversight, demanding stronger medical necessity proof, and closely reviewing high-value neurological procedures. These audits are delaying reimbursements, increasing administrative workload, and putting pressure on practice profitability. Neurology is one of the most complex specialties to document and bill. Diagnostic testing, chronic care management, and procedure-heavy treatment plans require precise records. When documentation is incomplete or inconsistent, claims become audit targets—even when care delivery is appropriate. Why Neurology Is a High-Audit Specialty Several structural factors make neurology more vulnerable to payer scrutiny: 1. High-Cost Diagnostic Testing Procedures like EEGs, EMGs, nerve conduction studies, and advanced neuroimaging carry significant reimbursement value. Payers demand detailed justification for these services. 2. Chronic Condition Treatment Plans Long-ter...