- +1 (773) 985-1869
- info@stream-rcm.com
- 14430 Ocean Point, El Paso, TX 79938
The neonatal care unit at Stream RCM navigates the complexities of NICU care including critical care, ventilation, surfactants, and gestational factors. Our professional team addresses documentation needs through experienced coders and payer knowledge, working directly with the clinicians to avoid denials. Preserve your NICU’s bottom line and mission through correct billing.
Stream RCM formed its NICU division based on mismanaged high acuity claims. We analyze the admission processes, level of care and payer contract prior to submitting claims. Physician documentation is reviewed and verified, gestational age and birth weight are compared to meet the requirement for coding, and all claims are monitored until they are adjudicated. Our coders have a background in perinatal medicine, as well as former billing managers and denials specialists who had experience working in regional hospitals and academic medical centers. We understand the differences between the 26-week micro-preemies and 36-week late-preterm admission, and it will be reflected in coding for both claims. Each and every neonatology account has its own pod which will familiarize itself with your documentation style and payer mix over time. This is what differentiates us from billing companies which use rotating staff and lack institutional memory when your unit needs it most.
It is based on the NICU level of care (Levels I-V) where we code all admissions with the appropriate level of care to document the acuity billed and reimbursement reflects the acuity used.
We manage surgical procedures on the newborn including necrotizing enterocolitis and congenital diaphragmatic hernias, working both surgeon and neonatologist claims to confirm shared-care days are included without double-billing.
Our team bills high-risk delivery and resuscitation in addition to newborn admission, billing for attendance at delivery, stabilization of newborn, and transition-of-care documents which are frequently overlooked on the first day.
We take care of billing for newborn transport where we code the time spent transporting, the type of transport, and the receiving facility documentation to ensure no transport revenue is left unbilled.
Our coders take care of routine and abnormal newborn screenings, hearing tests and metabolic panels. They link test result codes with diagnostic codes in order to prevent follow-up visit denials.
NICU Revenue Cycle Management from beginning to end follow steps from Eligibility Verification to Payment Posting. We pinpoint revenue issues and resolve them before it affects your profitability.
Your newborn will have eligibility and authorization verified upfront to avoid having coverage gaps interfere with their critical care services.
Our experts cross-reference the NICU daily census against charge capture for critical care and procedure codes that may be missed.
Each neonatology claim is scrubbed and checked according to payer-specific edits and modifiers prior to submission to reduce denials associated with poor documentation.
Your NICU denials are monitored and tracked by denial code and specific appeals submitted with appropriate clinical documentation.
Daily posting and reconciliation of payments against estimated reimbursements ensure your underpayments on complex NICU critical care claims are addressed.
Monthly reports include your NICU collections rate, denial trends, and days in accounts receivable compared to specialty standards.
Let our certified neonatology billing experts perform a free audit on your current billing system without any obligation to you.
Neonatology medical billing outsourcing to Stream RCM means that your revenue cycle will get expert management and tangible results. The healthcare providers face many financial challenges, including the shrinking margins of hospitals and the shortage of RCM staff in 63% of providers. Our certified NICU coders are aware of all ICD-10 changes and payer requirements to make sure the precision of coding and timely payment. Considering that the NICU claims denial rate exceeds 18%, it is essential to manage denials proactively. Prior authorizations, claims scrubbing, and analytics help detect where revenue is lost. When you partner with us, you will save on administrative costs, prevent errors, and receive detailed reports while your clinical team will concentrate on neonates. Research shows that neonatal billing improves reimbursement rates by 15-20% per year.
| CPT Code | Application & Related ICD-10 |
|---|---|
| 99468 | We verify accurate coding of the infant’s first critical care (birth age up to ≤28 days) along with ICD-10 code of P07.31 for severe prematurity, including all critical care minutes. |
| 99460 | Our team validates newborn examination billing (Z38.00) against birth record codes to make sure no mistakes are made in order to process healthy newborn claims without any hindrance. |
| 94610 | Our coders verify surfactant treatment (CPT 94610) along with respiratory distress syndrome (P22.0) to make sure ventilation days and medication days are matching. |
| 99291 | It is important to separate critical care units (99291) from NICU codes and associate P07.30 with the preterm infant, which is one of the most common denials that our team solves upfront. |
| 36510 | Our neonatal surgical coders code Umbilical vein catheterization CPT 36510 with P29.12 hypertension to make sure there is no overlap in billing between providers. |
Neonatal billing is related to maternal fetal care especially in cases where the patient is considered high-risk. Our team facilitates the process of billing between the mother and the baby to avoid any duplication of services, make the right global period selection, and increase chances of billing properly. We manage all the intricacies of billing from antenatal consultations to fetal monitoring and even delivery room management. This approach has enabled many of our clients to reduce claims discrepancies by 32%.
Our experts will flawlessly integrate your EHR, practice management system, and billing software. Your operations remain uninterrupted.
When NICUs increase bed capacity or become Level III and Level IV units, the billing and coding becomes more complex and numerous, and hospitals realize that their current workforce just can’t keep up. Our neonatal billing and coding solutions are designed to accommodate any sized unit from a twelve-bed community NICU to a seventy-bed academic referral center. We increase our coding staff without the recruitment and training time involved in bringing in a new internal hire, and each additional coder added to your account is trained specifically in your unique documentation style prior to ever handling live claims.
We handle common Neonatology billing issues through accurate coding, rigorous documentation assessment, and constant tracking of each claim from submission to payment.
This five-step timeline is followed by all infants from admission to discharge, so that billing can keep pace with clinical treatment rather than beginning when the baby comes home.
We note gestational age, birth weight, and diagnosis at admission, creating a billing file that is consistent with clinical records from the start.
Our coders review progress notes on a daily basis, noting critical care minutes and procedures as long as clinicians can still verify their accuracy.
We document every change in critical, intermediate, and step-down level-of-care to confirm accurate level-of-care billing each day.
A seasoned coder completes a chart review for the entire length of stay in conjunction with all procedures, consultations, and critical care.
Claims are released for processing and your team will be notified of the billable services and expected payment schedule.
It involves coding and billing for neonatal intensive care, routine newborn services, and NICU procedures. It requires specialized knowledge of weight‑based CPT codes, time‑based critical care, and ICD‑10 P codes for newborns.
Neonatal billing is uniquely complex due to weight‑based coding, time documentation, and dual insurance coverage (mother and newborn). Errors lead to denials and revenue loss. Specialists reduce these risks and improve cash flow.
Routine care (99460‑99463) is for healthy newborns; critical care (99291‑99292, 99468‑99469) involves life‑sustaining interventions. Misclassification is a common billing error we help you avoid.
Practices typically see a 98% first‑pass approval rate, 42% reduction in denials, and faster AR recovery. We provide transparent reporting on all key metrics.
Yes. We support Level I through Level IV NICUs, from small community hospital nurseries to large academic referral centers with surgical neonatal programs, scaling our coding capacity to match each unit’s admission volume and case complexity.
Improve collections, reduce outstanding invoices, and accelerate cash flow with expert-led AR follow-up services.
