Neonatology Professional Billing -- The Medx Specialties


Neonatal services are an array of services provided by physicians directing the inpatient care of critically ill newborns and infants. Neonatal care services involve high complexity decision making to manage, monitor and treat a critically ill patient.

We specialize in Level III NICU billing and have over 20 years experience in neonatal/newborn billing in several facilities in Southern California, Inland Empire and the largest Level III NICU in Los Angeles, Orange, and San Diego Counties.

Our office has expertise in selecting the appropriate CPT code to insure maximum reimbursement for physician transport and payer specific codes (for example Medi-Cal/CCS “Z” codes) for continuous hospital care at various critical care levels; low birth weight (LBW) or very low birth weight (VLBW).

For fast, efficient billing, Hospital Based Practices need to have electronic connectivity with hospitals for retrieving medical records and face sheet information. We make all the arrangements with the hospital for electronic retrieval of patient information by preparing HIPAA Business Associate Agreement and having our IT staff meet with the hospital’s IT department.

We review the CPT charge code assigned by the doctor and cross reference to the appropriate code for maximum reimbursement (example, global codes) within the insurance carriers guidelines (HMO, PPO, Medi-Cal, CCS, etc.). We eliminate any bundled codes which will cause a denial or reduced payment and bill codes which are not bundled like transfusions and the appropriate modifier depending on the type of transfusion.

We determine new patient’s insurance by using the hospital’s information and then re-verify for insurance accuracy and eligibility. To avoid claim denials due to time delays between the insurance carrier’s eligibility and claims processing departments, we also verify if the insurance company’s claims processing center has been updated with the newborn’s eligibility. If it has we will submit the claim electronically, if not, we submit a paper claim with a certified eligibility attachment thus receiving payment on first time submission.

A vigorous insurance follow-up system is utilized to collect on outstanding claims and we also leverage the reporting of unfair payment practices to the Department of Managed Health Care and Department of Insurance for slow payers.

We can also assist the physician group with insurance contract negotiations and credentialing.