Testing units and botulinum toxin billing cost neurology practices recoverable revenue every day.
Neurology runs diagnostic, drug, and in-office revenue side by side, EEG/EMG and nerve-conduction component counting, chemodenervation and high-cost neuro-infusion drug billing, and strict prior authorization on botox and biologics. Manual billing teams catch a fraction of the errors. Ember catches all of them.
Trusted by specialty groups and health systems
Where neurology revenue leaks
The denial patterns Ember was built for
Neurology runs diagnostic, drug, and in-office revenue side by side, and each line has its own denial trap. Testing unit and component errors, high-cost drug units, and medical-necessity scrutiny compound into systematic underpayment. Ember closes each gap.
01 · Diagnostic testing units & components
EEG, EMG, and nerve-conduction study counts and components miscoded.
When EEG, EMG, and nerve-conduction studies are performed, unit counts and the technical/professional component split routinely miscode, so multi-limb studies and extended monitoring underpay. Extended monitoring and staged-study rules add another layer. Ember validates every testing claim against payer unit and component rules before submission.
95816 · 95886 · 95910 · 9591302 · Buy-and-bill neuro drugs
J-code, unit, and wastage errors on high-cost botulinum toxin and infusions.
Botulinum toxin chemodenervation and MS/CIDP infusions carry high per-dose cost, and the smallest J-code, unit, or wastage-modifier error becomes a denial or takeback on an expensive claim. Buy-and-bill margins disappear when auth isn't confirmed first. Ember validates units and documented wastage (JW/JZ) and confirms authorization before the drug is administered.
J0585 · 64615 · J2350 · JW · JZ03 · Prior auth & medical necessity
Auth and documentation denials on chronic-migraine botox, biologics, and advanced imaging.
Payers apply strict criteria to chronic-migraine botulinum toxin, biologics, and advanced MRI imaging, and auth obtained doesn't always match the payer's current policy. Documentation gaps trigger denials on high-value claims. Ember flags the missing criteria before the service and builds the appeal package when denials occur.
64615 · J0585 · 70553 · L38530Three engines.
One source of truth.
Ember connects clinical documentation, payer policy, and contract terms into a single intelligence layer. Built for the diagnostic-testing, buy-and-bill, auth-intensive mix neurology billing spans every day.
01 · Foundation
Data Engine
Bridges the clinical and the financial. Unifies documentation, coding decisions, payer policy, and contracts across every encounter and provider.
R. Okafor
Encounter #N-52340
02 · Audit
Coding Engine
Reviews 100% of encounters against national standards, payer-specific policies, your internal guidelines, and your payer contracts. Every flag carries a rule citation.
Append modifier JZ — zero drug wastage
CMS drug-wastage policy · confidence 0.96
03 · Recovery
Appeal Engine
Reads CARC and RARC codes, identifies the applicable LCD/NCD policy and contract terms, drafts the appeal letter, packages documentation, and tracks every claim to adjudication.
Re: Claim #N-52340 · Denial CO-50
Chronic-migraine botulinum toxin meets medical-necessity criteria under LCD L38530: documented headache-day burden and failed conservative therapy, per contract §4.7…
Audit upstream.
Appeal downstream.
Two workflows do most of the work for neurology practices. The first prevents denials before they happen. The second recovers the ones that slip through.
Pre-bill audit
Catch the botox wastage issue before the claim leaves.
Ember reviews every encounter against coding standards, payer testing and drug policy, and your contracts. Testing unit and component errors, drug-unit and wastage gaps, and medical-necessity issues are flagged before submission.
- 1
Ingest the encounter
Pulls office notes, EEG/EMG and nerve-conduction testing reports, drug administration logs, and procedure codes from your EHR and practice management system.
- 2
Validate against rules
Checks testing units and technical/professional components, buy-and-bill drug units and wastage, prior-auth status, and medical-necessity criteria against each payer's specific policies.
- 3
Recommend with citation
Returns the suggested correction tied to the exact payer policy, LCD, or contract term.
- 4
Educate the provider
Coding patterns drive provider-level coaching, so testing documentation and drug charge capture improve across every clinician.
Append JZ + confirm auth — zero wastage, botox on file
CMS drug-wastage policy · confidence 0.97
+23%
Clean-claim rate
100%
Encounters reviewed
+5%
Net collection rate
Automated appeals
Pull. Review. Push.
When a denial occurs, Ember identifies the root cause, retrieves testing reports, drug administration records, and conservative-care documentation, references payer policy and contract terms, drafts the appeal, and tracks it through adjudication.
Medical necessity
Units/wastage
Testing component
Drug auth not on file
Botox appeal
-57%
Denial rate
-45%
Cost to collect
+9.3%
Net revenue per appt
The full revenue cycle
From eligibility to adjudication. Covered.
Audit and appeals are the workhorses, but Ember protects neurology revenue at every stage of the cycle.
Eligibility Verification
Confirms active coverage and testing and drug benefit structure before the visit, and flags buy-and-bill coverage gaps before they become billing problems.
Prior Authorization
Checks auth requirements in real time for chronic-migraine botox, biologics, advanced imaging, and infusions, generates medical-necessity documentation, and submits to payer portals automatically.
AI Medical Coding
Reviews 100% of encounters, EEG/EMG and nerve-conduction testing components, buy-and-bill drug units, and in-office services, against national standards and payer rules before claims submit.
Pre-bill Audit
Predicts and prevents denials before claims go out, catching testing unit and component errors, drug-unit and wastage gaps, and medical-necessity issues before they generate write-offs.
Denial Management
Full appeal lifecycle for every neurology denial type, medical necessity, testing component dispute, drug auth failure, and unit or wastage error, tracked to adjudication.
Underpayment Recovery
Parses contracts to model what each testing, drug, and in-office claim should pay, then surfaces line-item underpayments on high-cost buy-and-bill agents and testing at scale.
Testing and infusion neurology revenue, recovered
-57%
denial rate
-45%
cost to collect
100%
encounters audited
3 days
to first results
Based on Ember AI benchmarks across customer practices. Results vary by payer mix and specialty.
Frequently asked questions
Everything you need to know about how Ember fits into your revenue cycle.
- 50-75% reduction in FTE hours
- Faster cash acceleration
- Prevent 55%+ of denials
We provide ROI benchmarks and dashboards so you can track outcomes from day one.
See what your neurology practice is leaving on the table
Bring us 30 days of denial data. We'll show you where the revenue is and exactly how Ember would recover it.