480-821-1371

Successful Medical Billing in 2018 January 24, 2018

new year medical billingBilling in the new year, 2018, can come with a range of challenges for any size practice. From the extensive administrative burden of billing, to the time taken to get authorization from insurers, and preparing complex patient statements; it can be a difficult time that feels like a heavy weight on your back with ‘significant challenges’ being recognized in industry reports on billing.
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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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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 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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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.


Finding the Right Medical Billing Service in Iowa for Your Healthcare Practice November 27, 2013

Iowa flagEffective billing practices are necessary to keep companies in business – and healthcare organizations are no exception. However, with physicians eager to focus on patient care rather than back-end finances, it can be difficult to run a healthy business. This is where medical billing services come into play. In Iowa, third-party medical billing experts help medical practices maximize reimbursements and reduce costs, while putting patients first.

This trend is picking up all across the United States, according to a study released earlier this year by Black Book Rankings which found that 71 percent of practices are looking to improve revenue cycle management through a combination of outsourcing and new software. Outsourcing billing processes, after all, is often more cost effective than doing the same functions in-house. This is especially the case for small practices, organizations with a high turnover rate, and businesses just starting out.

For physicians in Iowa, a medical billing service can handle tasks and processes such as:

  • Entering data for all charges correctly for claims going to Medicare of Iowa and other payers
  • Submitting electronic and paper claims to primary and secondary insurers , including Blue Cross Blue Shield and Medicaid of Iowa
  • Knowing the information that Wellmark-Blue Cross Blue Shield and Medicaid of Iowa require to get paid
  • Tracking and following-up on unpaid claims
  • Posting payments
  • Preparing patient statements
  • Customizing medical billing reports

Whether you are interested in having a third-party billing service in Iowa take over your practice’s entire billing process or just a few parts of your business, choosing the right outsourcing partner can be the right move for your business. It can help you eliminate expenses, reduce denials, and increase payments coming in to your practice.

If you don’t currently have a billing or practice management system, find a billing service that uses its own software; and find out whether it can interface with your electronic health record system. Many medical billing companies can also adapt to the needs of your practice by working with your existing billing software. This is important, seeing as the most efficient billing departments tend to be those whose organizations have implemented fully integrated EHR and practice management platforms. An integrated solution can help improve charge capture and reduce denials. Most importantly, it can help you get paid faster.

There are many benefits to working with an Iowa medical billing service. To find out how 5 Star Billing Services can help your practice be more successful, call 480-821-1371.


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.


What to Expect From a Florida Billing Company November 20, 2012

Healthcare professionals are sometimes hesitant about outsourcing medical billing and collections, but the fact is many third-party billers are capable of collecting just as effectively as in-house employees – and for a lower cost. In fact, a successful medical billing company will act as an extension of your staff and will possess the resources to perform billing processes more efficiently than even your most skilled biller. At 5 Star Billing Services, we have the knowledge and expertise to do so.

Here are some of the services our Florida billing service offers healthcare organizations like yours:

Personalized attention. We understand the benefits of working with billers who know your practice and understand your medical specialty. Therefore, we make it a point to assign account executives with backgrounds comparable to yours. This will ensure that the professionals handling your practice’s billing tasks know your practice best.

Setup for new practices. New practices often experience delays in payment due to administrative oversights and poor planning. Whether you are running a family practice or surgery center, 5 Star Billing Services will help with all aspects of the billing and collections setup in order to prevent surprises and denied claims. This includes:

  • Insurance credentialing
  • Training for front desk staff
  • Top-quality billing software

We also provide our clients with a guarantee that things will get done correctly the first time around. By providing a hands-on approach to medical billing and collections, our staff can help you:

  • Get paid faster through speedy claims processing, 24-hour payment posting, and aggressive follow-up on denied claims.
  • Reduce costs by automating billing and collections processes and by eliminating the continued hiring and training of billing staff.

Do you have questions about how our Florida medical billers can save your practice time and money and help you focus on practicing medicine? Contact us to learn more.


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.


Medical Billers Help Colorado Physicians Maintain Healthy Accounts Receivables October 10, 2012

Not even the best doctors can run a medical practice on their own. That’s because the success of any healthcare organization is dependent on the health of its accounts receivables and not just on the medical services that its physicians provide. In fact, even if a doctor provides the best medical services in Colorado, if he has inexperienced billers, chances are his practice isn’t going to be around long. In order to prevent this from happening, many Centennial State physicians have chosen to partner with experienced Colorado billing services and have seen positive results.

What do medical billers do?

Medical billers receive information from physicians about the services that patients received and the procedures that they underwent. Billers use these codes to submit claims to insurance companies and other payers in order to receive payment for services rendered. An expert biller should understand standard billing procedures used by most insurance companies, as well the different classification systems, ICD and CPT. ICD codes are used to describe what was wrong with the patient (diagnosis), while CPT codes describe the services that were performed (i.e. administered flu shot or performed physical examination).

What functions does a medical biller perform?

Billers are largely responsible for a medical practice’s financial stability, as whether or not a physician gets paid can depend on how effective the biller is at submitting complete, accurate claims in a timely fashion. Some of the other functions that medical billers perform include:

  • Reading and understanding EOBs (explanations of benefits)
  • Reviewing physicians’ codes for potential downcoding
  • Following up on claims that have not been paid after 30 days
  • Reviewing denied claims and gathering information in order to appeal them
  • Billing secondary and tertiary insurance providers
  • Sending bills out to patients for services that were not covered by their insurance

If you are a Colorado physician and you need assistance with any of the aforementioned billing tasks, consider hiring a third-party billing service in Colorado. Contact us today to learn more about the benefits of medical billing outsourcing, and we will tell you all about the services we provide and the physician specialties that our billers have worked with.


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