Health Plans

Our company will work with your team to perform a comprehensive analysis of all epilepsy testing performed within the network. We have a target list for specific CPT codes and will help your team interpret the data and identify providers who are candidates for post-payment audits and reviews. Due to the high value of long-term EEG monitoring services, a relatively small number of claims can yield significant returns for your network.

In 2020, the American Medical Association (AMA) and CMS retired 3 legacy CPT codes for long-term EEG monitoring and introduced 23 new CPT codes. The new codes have specific requirements for monitoring but do not address medical necessity for the level of monitoring and interpretation that is ordered for patients. Our team will perform a risk analysis of all your network’s clinical and billing policies related to long-term EEG monitoring. After the audit, we will provide your organization with recommendations that will substantially reduce the risk of overpayment to providers.

1 out of every 26 Americans is diagnosed with Epilepsy. There have been advancements in technology that provide a convenient and cost-effective alternative to traditional hospital-based EEG monitoring. Our team will perform a robust audit of your network’s service area and current providers. We will provide your organization with a SWOT analysis and make recommendations that will lower your network’s costs and expand access to care.