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How to Turn Your Revenue Cycle Management Process Around September 25, 2017

Revenue Cycle ManagementThe efficiency of the your practice’s revenue cycle can have a critical impact on financial performance, and effective management of the cycle is of utmost importance to your practice. However revenue cycle management within health practices is becoming increasingly difficult, with greater administrative responsibilities and regulatory pressures. This article outlines the problems practices are facing and how to turn the revenue management process around.

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Why Outsourcing Your Medical Billing Process Makes Sense For Private Practices July 18, 2017

Transform Your Practice Into a More Efficient One With Higher Revenue

Stethoscope on top of medical billing papersBilling is an extremely important part of operations for a medical private practice, and a quick and efficient billing process is a key driver of revenue. In order to ensure that your doctors are paid for their services, two main things must happen: First, the claims for services must be submitted in a timely manner. Second, the claims for services must contain the correct codes for procedures, treatments, and other services.
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What to Ask a Medical Billing Service Before Hiring Them May 31, 2017

Medical Billing ServiceHiring a skilled medical billing service can help your practice by greatly reducing administrative costs, ensuring an uninterrupted cash flow, increasing your bottom line, and — most importantly — allowing you to focus on medicine and patient care. But first, you have to choose the right team to work with. Here are the three most important questions you should ask before choosing your medical billing service team.

1. How much does your service cost?

This is probably the first question on your mind when choosing a medical billing service.  It is important to obtain complete information on a few key facets of cost in this discussion:

  • What the monthly bill amounts to, and whether it’s a flat rate or a percentage of charges collected: Because medical billing services should help you to increase collections, the percentage option is a good one as it aligns the service’s incentives with your practice’s goals.
  • Additional fees: On top of the monthly cost, billing services may charge additional fees for initiation, termination, or data conversion. It’s important to factor in these extra costs when you are comparing billing service price tags.
  • What services are included: Medical billing services aren’t always made equal, and a cheaper service may be a less comprehensive service. Find out exactly what kind of billing assistance is included and excluded, and ask about different packages that may be available to determine which one best suits your needs.

2. How will my account be handled?

From patient data security to reporting frequency, there are a few things to consider with respect to how a medical billing service will work with you.

  • HIPAA compliance: The HIPAA law dictates that all covered entities (providers) and business associates (any companies you contract) adhere to regulations. Everyone who handles protected health information is responsible for ensuring that patient data remains private and is kept and transmitted securely, and committing to breach notification practices. Ask about the medical billing service’s HIPAA compliance plan. What measures do they take to keep your data safe?
  • Reporting: Outsourcing a key function of your practice can induce stress if you’re not kept in the loop. Ask about the frequency of reports, and what each report will include. For example, 5 Star Billing provides monthly practice analysis and collections reports, in addition to customized and on-demand reports. Knowing what kind of information you can expect to receive on an ongoing basis and what you can request can help you choose which service you will be most comfortable working with.
  • Billing software: What billing software does the medical billing service use? You want something that will work well for your staff and your patients, and make the transition as smooth as possible.
  • Account manager: Who will actually be handling your account, and what happens when the person is out of the office? Because medical billing is time sensitive, you want to make sure that you’re always covered, preventing surprises for your practice and  your patients.

3. What qualifications do your service and staff have?

Is the billing service you are hoping to contract professional and good at what they do? When you ask about qualifications, be sure to cover the following.

  • Billing experience: Skilled medical billing involves in-depth knowledge of medical codes and experience working with patients and doctors, and it is especially helpful to work with someone who knows your specialty. This means that your biller understands the conditions and procedures in your field, and can use this expertise to help you maximize collections. A medical billing service with an established portfolio and experience in your medical specialty is the best choice.
  • References: Who can give you a better idea of what it’s like to work with this medical billing service than a doctor who has hired the same service before? Asking for references can give you an idea of what other providers’ staff and patient experiences were like.

Offering healthcare providers customized medical billing services across over 30 medical specialties, 5 Star Billing bundles billing, collection and administrative services — helping you to maximize the time they spent doing medicine. Start the conversation with our specialists at 5 Star Billing online or by calling 480-821-1371.


Why is Medical Billing Training and Certification Important? February 21, 2017

Medical Billing Training and CertificationMedical billing professionals play an essential role in healthcare. Their work is complex, detail-oriented, and directly affects the financial well-being of healthcare practices. The demand on healthcare providers is increasing, and ambiguity among payers can make claims processing a frustrating process. For this reason, many practices are enlisting the help of trained, certified medical billing professionals to ensure efficiency of their revenue cycle management.

But what exactly are the advantages of hiring a trained and certified medical biller?
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How Will the Change From Fee-for-Service to Value-based Care Affect the Revenue Cycle? January 17, 2017

Graphic explaining revenue cycle management through health insuranceThe Centers for Medicare and Medicaid Services are phasing out fee-for-service care and replacing it with a value-based model in an effort to improve the quality of care for patients. This transition is promoting changes that will ensure better care at a lower cost. But exactly how will this affect the revenue cycle?

We outline a few important changes occurring in the move to value-based care in order to help you prepare a value-based revenue cycle.

RCM is Now An End-to-End Process Where Customer Service is Essential

The patient experience is more than just clinical care. Providers will need to change their approach to patient intake by having staff members take on more of a customer service role. This is especially important for recurring patients. Sit down with each patient and help them understand the financial details of their health care, from pre-admission through the entire care process. Increased interaction, patient education, and patient assistance through this hands-on approach dramatically improves the patient experience, and in turn, increases revenue for your practice

Additionally, front-end revenue cycle processes are now more important than ever, meaning that collecting the correct patient data before service is critical to ensuring clean claims. In order to improve revenue, providers should emphasize eligibility authorization, collection of copayments, and collection of patient deductibles.

The Process of Care is Shifting to Slow Spending

Patients with chronic disease, such as diabetes and congestive heart failure, require the most resources when providing care. This is because they are most likely to be repeatedly admitted into the hospital and frequently visit their physicians or emergency care centers. In other words, they are the most expensive patients to care for. In order to reduce hospitalization and emergency costs allocated to this population, providers must focus on providing a different kind of care with a different objective, that of a preventative approach.

In this care model, the focus shifts to identifying gaps in care delivered to patients with chronic disease in order to reduce total-care spending, increase the value of care by reducing unnecessary readmissions, and increase revenue for providers. By implementing a new care model for patients who are at risk of hospitalization, total care spending slows for this population, leading to savings and more sustainable revenue cycle management.

Data is King

Data is the most important asset when it comes to value-based care. In a value-based environment, it’s critical for providers to have as much information as possible on patient medical history.

Additionally, it is important for providers to have the ability to analyze their performance of quality reporting measures. Understanding performance is key to determining whether providers are performing sufficiently enough for a positive reimbursement payment or if their performance is in line with a negative reimbursement payment.

If you have been using EMR software and meeting the necessary requirements to fulfill Meaningful Use, then you are already obtaining and maintaining comprehensive information.

Partner With The Right EMR

5 Star Billing is dedicated to helping practices streamline operations in order to achieve value-based care. With the right EMR and practice management software, practices can ensure accuracy in patient data as well as an improved patient experience through the entire cycle of care.

To learn more about how we can help ensure clean claims and maximize your revenue, contact us online or call us at 480-821-1371.


How Smarter Medical Collections Can Improve Your Practice’s Finances October 25, 2016

Medical CollectionsAccording to the America’s Health Insurance Plans’ Census of Health Savings Account – High Deductible Health Plans, the number of individuals enrolled in a high deductible health plan reached 19.7 million in January of 2015. This number is a dramatic increase from the 17.4 million reported in 2014.

With payment responsibility heavily shifting toward the patient, physicians need to change their strategy for collecting payments.
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Steer Clear of these Medical Billing Mistakes for a Successful Healthcare Revenue Cycle September 29, 2016

Medical Billing Mistakes Can Cost You MoneyEfficient revenue cycle management ensures that healthcare providers can focus on what matters most: giving quality care to their patients. However, providers often struggle to bill effectively. Below are the most common errors committed by practices and clinics that prevent them from billing properly and collecting on money that the practice is owed.

Collecting incorrect patient information

The collection of patient data is the foundation upon which claims can be submitted and paid. Errors such as a misspelled name or an incorrect date of birth will result in a denied claims payment. Administrative staff should make a habit of double-checking the accuracy of information collected during the initial interactions with the patient.

Failure to check the patient’s insurance coverage

In the first quarter of 2016, the American Hospital Association reports that 43 percent of hospitals in the U.S. have spent more than $10,000 on managing claim denials, while 26 percent have spent more than $25,000.

It is important to evaluate the patient’s insurance plan and eligibility each time they schedule an appointment. The following questions can serve as a guideline for administrative staff when evaluating eligibility:

  • Does the patient have valid insurance that is accepted by your practice?
  • Does the patient have additional insurance?
  • Is all patient registration information correct?
  • How many visits is the patient allowed?
  • What is the patient’s responsibility regarding the cost of the visit?

Not informing patients of their payment responsibility

Within the past decade, the amount of high-deductible insurance plans has increased exponentially. This means that patients are taking on a greater financial burden in the payment of medical bills. Additionally, the cost of collecting payments from patients is higher than that needed to collect from payers, as it requires more time and money. This need for more resources is placing an even greater financial strain on hospitals and practices that are already struggling to collect payments and bring in owed revenue.

In order to ensure that patients are fully aware of their financial responsibility, clearly inform them of the balance due, and collect at least a portion of this balance at the time of the visit.

Manually submitting claims

The implementation of the new ICD-10 billing code proved to be less traumatic than anticipated. However, the American Health Information Management Association (AHIMA) has identified several recurring mistakes in submitted claims, and it will take some time for administrative staff to become proficient in the new code as well as the new documentation practices. Billing errors due to manual reporting can result in a significant loss of income and productivity.

Billing in-house when your staff is overworked

When a practice’s workload is high, administrative processes become less efficient and billing mistakes can be easily made. Keeping up with annual medical code revisions and billing practices add extra expectations that may overwhelm your staff.

Outsourcing billing services increases claims payments, decreases labor costs as well as resources allocated towards in-house billing, and overall increases revenue for hospitals, practices, and clinics.

To learn more about how outsourced medical billing services can help you make more money, limit overhead expenses, and make your practice more efficient, contact us online or call us at 480-821-1371.


Increase Your Revenue in 2016 with Professional Billing Services February 1, 2016

billing services for medical practicesMedical billing is a crucial part of running any healthcare practice. Providers depend on accurate and efficient billing practices in order to receive reimbursements from payers in a timely manner.

With numerous PQRS and meaningful use requirements, running an efficient practice is becoming more difficult. Staff members and healthcare professionals are required to stay up to date with PQRS, meaningful use, and a new ICD-10 code. It can be easy to become overwhelmed and frustrated with billing tasks when your top priority is giving your patients the time and attention they need.

Reimbursements from payers aren’t always clear or timely, and it can become burdensome to keep up with the costs of running a practice. Roughly $125 billion dollars misses the hands of physicians due to billing errors each year. Outsourcing billing services can solve numerous administrative difficulties and can help your practice dramatically increase revenue.

Reduce billing errors to ensure claims payment

Insurance companies are sticklers when it comes to correctly reporting medical codes and adhering to billing regulations. A missed code or billing error will result in a rejected payment. If this happens, physicians then have to enter into a long process of interaction with the insurance company in order to fix the mistake and apply for the payment a second time.

Medical billing professionals are thoroughly trained and experienced in medical billing to ensure accurate reporting so that providers get paid the first time a claim is sent. Accurately submitting claims results in increased reimbursements for the practice and quicker receipt of these payments.

Comply with medical billing rules and regulations

Billing regulations change frequently and cause frustration for physicians who are busy keeping up-to-date with changes regarding PQRS and meaningful use regulations, as well as learning an entirely new ICD-10 code. In addition, continuing education and training courses can be costly and time-consuming.

Lack of medical necessity is a common billing error that occurs when sufficient information for a patient’s diagnosis is not given to the medical coder. This could then lead to submitting a bill with the wrong code, and a denied claim by the insurance company.  Medical billing professionals stay current on all medical billing regulations, medical procedures, and ICD codes, ensuring compliance and lower cost for the practice.

Save money to allocate office expenses elsewhere

Smaller healthcare practices tend to place billing responsibilities on administrative staff, giving them too much responsibility and spreading them too thin. Overwhelmed by office tasks and ensuring a comfortable patient experience may not allow office staff the time to ensure maximum return on claims. In addition, too much work and office responsibility do not allow them the time to resubmit denied claims or to fight for delayed payments.

For hospitals and large clinics requiring their own billing department, office space needed for a billing department and the costs of retaining employees also present a financial burden. Using a medical billing service also helps ease the stress of retaining employees needed to staff a billing department. By outsourcing billing, practices can cut costs on office expenses, costly software updates, and can allow administrative staff to focus on their primary responsibilities.

Make operations more efficient

Administrative tasks are becoming more convoluted with PQRS and meaningful use requirements. A lot of time is used to educate staff members on the regulations that change frequently. Outsourcing billing services help ease the administrative workload in the office, so staff members can focus on running an efficient practice. With less burden of responsibility in the office and more efficiency, the practice may even be able to accept new patients and take more appointments throughout the day, whereas before this may have seemed impossible.

Retain existing patients and entice new ones

Physicians may easily become distracted by billing compliance and reimbursement disputes from payers. Delayed or denied payments can cause frustration and can significantly decrease the quality of the practice and may even affect the retention of patients.

Spending less time on admin work means that healthcare professionals can then focus more on patient relationships and care. This type of environment will help any practice retain current patients and attract new patients. 

For more information on medical billing services, contact us online or call us at 480-821-1371.

This article originally appeared on the 1st Provider’s Choice blog.


How Can Minnesota Healthcare Providers Prepare for ICD-10? February 19, 2013

Medical billingOctober 1, 2014 is an important date in the healthcare industry, and it is approaching fast. Physicians eligible for participation in the EHR Incentive Programs will face Medicare payment adjustments if they haven’t demonstrated meaningful use of certified EMR technology by that date – and it is also the deadline for medical professionals to start using ICD-10 codes. Working with a Minnesota billing service is one way providers can tackle the transition without feeling overwhelmed.

Many billing companies help ease providers’ strains by helping to establish conversion plans, conducting testing prior to the October 1st deadline, and even offering continued ICD-10 support. To ensure that that your practice’s revenue cycle management processes are not affected once the new codes go into effect, be sure to talk to your billing service or clearinghouse. Find out whether their systems can accommodate ICD-10 codes, when their upgrades will be completed, and when you can start sending transactions for testing.

In order to accommodate ICD-10 diagnosis and procedure codes, healthcare organizations will also need to make adjustments of their own. This includes conducting assessments of all health IT systems that might be affected by ICD-10 and carrying out necessary upgrades to ensure that the new coding system will function properly. Coding and billing staff will also have to be trained on working with the new codes in order to avoid cash flow interruptions.

About ICD-10

The tenth revision of the International Classification of Diseases (ICD-10) includes:

  • ICD-10-CM: the diagnosis code set that replaces ICD-9-CM Vol. 1 and 2
  • ICD-10-PCS: the inpatient procedure code set that replaces ICD-9-CM Vol. 3

ICD-10 features 68,000 diagnosis codes and 87,000 procedure codes – a significant increase from ICD-9, which includes 14,000 and 4,000 codes, respectively. For many physicians, just looking at the numbers can be overwhelming. However, the good news is that many of the codes are only slightly different. For example, the only difference with approximately one-fourth of ICD-10 codes is that they specify the side of the body. Meanwhile, another fourth of codes differ in how they distinguish between:

  • Initial encounters (i.e. initial fracture)
  • Subsequent encounters (i.e. follow-up of fracture healing normally)
  • Sequelae (complications or conditions that arise as a direct result of an injury, disease or event; i.e. follow-up of fracture with malunion)

Is your healthcare organization looking for a Minnesota billing service that is ready to start working with ICD-10? Contact us online or call 480-821-1371 to speak with one of our expert representatives.


Nevada Medical Billers Help Increase Patient Payments October 30, 2012

Though the Affordable Care Act has put medical insurance within the reach of many, healthcare costs continue to rise and patients are paying more money out-of-pocket than ever before. When patients are unable to cover the cost of care (whether it is due to high co-payments and deductibles or financial difficulties), it can make healthcare organizations experience disruptions in cashflow and even lose money owed for serviced rendered – and this is something that no Nevada physician wants.

The good news is that there are ways for providers to increase patient payments, and working with a Nevada medical billing service can help. Here’s how:

Monitor patient accounts and payment status on a regular basis.

When healthcare practices are understaffed, it can be difficult for employees to keep track of past-due accounts and late-paying patients. However, continuously following up with these patients is the only way to ensure payment. By hiring a Nevada medical billing service, physicians can focus on the medical side of the business while billing experts handle billing and collections. This can involve working out payment plans with patients and monitoring accounts to ensure that payments are being made on time.

Appeal denied claims.

When an insurance company denies a medical claim sometimes the healthcare facility ends up writing it off, but other times the responsibility falls on the patient. With either scenario, the medical organization can end up losing money. Not all denied claims are rightfully denied, however, and medical billers should know how to spot ones that can be resubmitted for appeal. By using electronic claims processing software, for example, experienced medical billing companies are able to track all submitted claims, find the reason why certain ones are denied, and collect the information necessary in order to appeal them.

Check if patients qualify for Charity Care Assistance.

Uninsured and underinsured patients who receive medical treatment at hospitals are often left with large medical bills to pay and don’t have the resources to do so. This means that very often hospitals bill for services but never receive reimbursement, as patients are financially unable to make payment. There are, however, government funds which can help patients and hospitals in these types of situations. The problem is that many patients do not know about these programs, and therefore never apply to see if they are eligible for aid. Hospitals who wish to increase patient payments should work with patients facing financial difficulties to verify charity care eligibility. In order to qualify, patients are typically required to meet all three of the following requirements:

  • Have no health coverage or partial health coverage
  • Do not qualify for private or government-sponsored coverage
  • Meet specific income and assets eligibility criteria (varies)

Third-party billing companies often help healthcare organizations determine patient eligibility and can also set up payment plans for patients who do not qualify for charity care or only qualify for partial assistance.

Are you looking for a medical billing company that can help get your organization’s accounts in order? Contact 5 Star Billing Services at 480-821-1371 to learn more about the benefits of working with our five-star billers.


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