rcm solutions Neonatology facilities

Medical Billing And Revenue Cycle Management Solutions For Neonatology Facilities

Neonatal facilities provide specialized care for sick or premature newborns. Given the highly specialized and sensitive nature of neonatal care, billing of these facilities requires a deep understanding of complex coding, modifier usage, and payer-specific documentation rules. At StafGo Health, we provide specialized medical billing and revenue cycle management (RCM) solutions made for neonatology practices, keeping in mind their specific needs and requirements.

Neonatology Focused CPT Code Management With Stafgo Health

Neonatology billing involves various CPT codes of a highly specific and time-sensitive nature, which reflect the complexity and intensity of care provided to newborns. Our certified coding team manages the most commonly used codes in neonatology, including 99460–99463 for initial and subsequent hospital care for normal newborns and 99468–99476 for critical care services in neonatal and pediatric intensive care units. They also bill for the services like 99471 and 99472 for subsequent intensive care for infants less than 28 days old and 99475–99476 for those aged 29 days to 24 months. Procedures such as endotracheal intubation (31500), umbilical line placements (36510, 36511), and ventilator management (94002–94004) are also integral and well managed.

Why Outsource Medical Billing And RCM To Stafgo Health For Your Neonatology Practice?

Outsourcing medical billing and coding ensures that the most critical financial aspects of your practice are taken care of, allowing you to focus on patients’ well-being. Hence, outsourcing your billing and RCM to StafGo Health for your Neonatology practice would mean partnering with a team that truly understands the complexities of neonatal care billing.

Common RCM Challenges Faced by Neonatology Practices

Frequent claim denials and underutilized reimbursable services impact the financial performance of your practices, and, without a specialized RCM partner, it results in delayed reimbursement.

Here are some of the common Revenue Cycle Management (RCM) challenges faced by Neonatology practices:

Complex and Time-Based Coding - In Neonatology, time-sensitive codes are used, e.g., 99468–99476 for intensive care services, which require correct documentation of time and duration. Any error in this can lead to denials or underpayments.

Bundled Services and Modifiers - To identify the different or separate procedures, many neonatal services are bundled or require the correct use of modifiers (e.g., 25, 59, 76). The application of wrong modifiers can lead to claim rejections.
Frequent Insurance Preauthorization Requirements - Insurers have to take Preauthorization for some procedures, like NICU (Neonatal Intensive Care Unit) admissions or extended hospital stays. Delays or mistakes in this process can delay the reimbursement.
Multiple Payers and Coverage Types - Sometimes, claim rejection occurs due to confusion if eligibility isn’t verified properly from the beginning, because neonates can be covered under various policies (mother's, father's, or Medicaid).
Documentation Inconsistencies - Sometimes pediatric specialists and hospital staff have different document standards, which leads to the submission of incomplete or non-billable claims if not coordinated well.
High Denial Rates for Level-of-Care Disputes - Level-of-Care Disputes is also one of the problems that is frequent in neonatology. Insurance companies frequently challenge the medical necessity or level of care billed (e.g., Level III vs. Level IV NICU), leading to denials or downgrades in reimbursement.

Solving Your Neonatology Practice’s Challenges with StafGo Health

Expert Handling of Time-Based and Intensive Care Codes - Our Certified coders are experienced in applying time-based CPT codes (e.g., 99468–99476), hence, assuring the correct documentation and maximizing reimbursements for neonatal intensive care services.

Precise Modifier Usage and Unbundling Expertise - Our team ensures that bundled services and appropriate modifiers are correctly identified and applied, which prevents unnecessary denials and ensures that full payment for all billable services is achieved.
Streamlined Authorization and Eligibility Verification - Our team proactively and quickly manages prior authorizations and verifies newborn eligibility regarding the parent's insurance, which can prevent delays in reimbursement and payer confusion.
Reduction in Denials and Level-of-Care Disputes - Our team analyzes all the essential documents to justify higher-level NICU billing and make sure that your practice is in compliance with payer-specific requirements, which can reduce the disputes and increase the chances of reimbursement.
Seamless Coordination with Hospital Billing Departments- Our team comprises professionals who ensure the synchronization between the facility and professional billing to avoid overlaps, missed charges, and administrative delays.
Compliance with Evolving Regulations - Our team stays updated with ever-evolving payer guidelines, CMS regulations, and neonatal billing best practices, which can help your practice stay in compliance and avoid audit risks.