Eligibility, Verification & Preauthorization

Neurosurgery is authorization-intensive. Our team handles:

• Preauthorization for surgeries, injections, imaging, and implantable devices
• Clinical notes and imaging submission
• Documentation alignment with payer medical necessity guidelines
• Implant/device eligibility verification
• Deductible & out-of-pocket responsibility mapping

Operative Note & Documentation Review

We conduct a deep-dive review of:

• Surgical approach and technique
• Anatomical level specificity (e.g., L3–L5)
• Device and implant logs
• Number of levels decompressed or fused
• Use of microscopes, navigation, and intraoperative monitoring
• Surgeon’s dictation accuracy vs. coded procedures

Neurosurgery Coding & Charge Capture

• Multi-level spinal coding with correct hierarchies
• Device/implant HCPCS mapping
• Distinguishing add-on codes from standalone codes
• Ensuring CCI compliance for bundled procedures
• Correct anesthesia and monitoring charge capture

Claims Submission & Revenue Integrity Checks

• Global surgical period validation (10, 90-day)
• CCI edit analysis to prevent bundling errors
• Payer-specific neurosurgery guidelines applied
• Pre-submission checks for high-value claims

Neurosurgery Denial Prevention & Management

We aggressively manage denials such as:

• Documentation insufficiency
• Missing or incomplete imaging evidence
• Bundled vs unbundled spinal procedures
• Medical necessity denials for decompression & fusion
• Global period conflicts
• Implant reimbursement disputes
• Prior authorization rejections

AR Calling & Appeals Optimization

Because neurosurgical claims are high-value, AR management is meticulous:

• Dedicated follow-up for all surgical claims
• Appeals referencing operative note anatomy & technique
• Clear explanation of medical necessity for fusions, revisions, and tumor resections
• Device and implant underpayment recovery
• Tracking payer delays and escalating when needed