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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.


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.


Preventing Billing Mistakes with the Help of Expert Oklahoma Medical Billers October 30, 2013

Medical billing mistakes can lead to claims denials and delays in payment, affecting Oklahoma healthcare providers’ bottom lines. To prevent mistakes, increase cash flow and improve revenue cycle efficiency, providers often choose to outsource their revenue cycle needs to an Oklahoma billing service. Doing so saves time and money and ensures that billing processes are being carried out correctly.

If your practice is experiencing increased denials due to billing errors, here are a few ways a medical billing service can help:

Implement practice management software.

If your practice isn’t using practice management software yet (what are the odds?) your medical billing company will likely implement one for you. This is due to the fact that medical billing services tend to offer complete outsource solutions, and they require practice management software to facilitate the different billing processes. From automatic charge capture to claims scrubbing and submission, PM software helps eliminate possibilities for mistakes along the revenue cycle.

Verify insurance.

verify insuranceFiling an insurance claim with incorrect or outdated policy information is one of the main reasons claims get denied; and preventing this type of denial requires little effort. In fact, with the help of an Oklahoma billing service physicians can prevent these denials altogether. Before a patient’s appointment, a medical biller will contact the insurance provider (sometimes by phone, sometimes using payer websites), verify effective dates and coverage period, and find out deductible and co-pay amounts for different types of visits.
Insurance verification should be carried out for every patient without exception. It doesn’t matter whether the patient is new, is returning after a year, or is coming back for a 4-month follow up appointment. Having correct insurance information is imperative to getting paid on time.

Check for errors in patient information.

Another reason claims frequently get denied is due to wrong patient information or omitted data. This can include a patient’s name being misspelled, the date of birth being entered incorrectly, or a diagnosis code not matching up with procedure that was performed. Because front desk staff is often unable to double-check these details, an Oklahoma billing service can contact patients ahead of time to obtain this information for you.

Are you interested in learning more about our medical billing services? Contact us today by calling 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.


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