Medical Billing Service Company
How Does 5 Star Billing Services Do It?
Our Proven 5 Star Medical Billing Process is guaranteed to improve your collection percentages. The 5 Star Medical Billing Process includes:
- Efficient, accurate and complete data exchange
- Electronic and paper claims processing
- Aggressive AR follow up and insurance collections, payment postings & EOB analysis
- Patient Statements and balance collections
- Monthly practice analysis & collections reporting meetings
Speak with a Medical Billing Specialist today!
Increase collections, decrease claims denials, and maintain healthier accounts receivable.
Getting Started With 5 Star Billing Services
Before we can even begin our 5Star Billing Services process, the first step is to determine your needs, learn what is important to you and how we can best help meet your goals.
Efficient, accurate and complete data exchange
Initially we ensure that the overall transition and implementation process is handled smoothly and efficiently. We will seamlessly migrate data from your current billing system or service provider. Then we focus on integrating systems and processes. We work with your staff to ensure that correct information is exchanged in a timely manner. We will work as closely as possible to do things correctly the first time so we can obtain the highest reimbursement possible in the shortest period. We have set up systems to facilitate a very efficient exchange of information. We will train your staff so that we can work as a team. Most Practices prefer a 5 Star team member to enter new patient information directly into our software from the patient intake documents. We double-check the data for accuracy and completeness before generating claims. Accurate and complete patient information is the first step to getting claims paid successfully.
Electronic and Paper Claims Processing
We are passionate about processes, because we know that a well-managed process prevents errors and maximizes the output ensuring that billing errors are corrected before they become problems. We catch incorrect codes, data-entry mistakes, and missing information to avoid costly delays, denials, and resubmissions. Delays are minimized and AR days reduced as we scrub claims before they are submitted. We excel in accurately coding and billing for professional fees and medical equipment and supplies. We keep current with insurance specifications and regulations and ensure the fees are kept at the maximum allowable reimbursement. We also focus on procedure codes so claims are not suspended or rejected. We process Secondary Carrier claims upon receipt of the primary carrier EOB making sure that you receive the maximum amount covered by the insurance companies and minimizing out-of-pocket expenses to your patients.
Most claims are sent electronically on a daily basis. Paper claims are usually mailed weekly.We process claims for Medicare, BC/BS, Medicaid and 1900 other payers. We also handle Workers Comp, Personal Injury, Cash Payments, HMO and PPO claims and payments.
Aggressive AR Follow Up, Insurance Collections, Payment Postings & EOB Analysis
Each EOB is audited for correct payment and/or benefits and credited appropriately. When necessary, immediate steps are taken to process and repair unpaid or reduced claims to ensure that you receive every possible penny. Checks are mailed directly to you.
We continuously track your net collection rate (the actual payment vs. the contracted rate) to ensure you are getting your fair share. 5 Star Billing Services will improve your net collection rate and your average collection per charge, which translates to more money in your pocket. Our goal is to help you get started or to help you improve your existing practice. Remember, if you don't get paid, we don't get paid. It is to our mutual benefit to collect the full reimbursement for services rendered.
Each month we work on the accounts receivable aging report. When a claim is not paid, we research and fix the problem and resubmit the claim. We will reduce your accounts receivable days outstanding, which means less of your money is tied up. We aggressively track, manage, and follow up immediately on all denials
Patient Statements and Balance Collections
We manage all patient billing including printing and mailing all patient statements and follow-up statements, and we handle all patient questions and calls. We audit for accuracy before we send statements to patients. We create clear, concise and informative patient statements to minimize the number of calls from patients needing clarification of their bills - fully customizable (summary or detailed format). We also write and mail patient collection letters.
Monthly Practice Analysis & Collections Reporting to Regain Control of Your Business
5 Star Billing Services helps you unlock the insights and intelligence within your own data to help you run your business better. We offer complete reporting solutions, including customized and on-demand reporting. In addition, we analyzing your data and draw the conclusions required to continually improve your business. We run reports to identify denials or difficult payers and follow-up with calls and appeals. Reports include:
- Instant access to accurate aging to know who is really delinquent
- Collection calls
- Follow-up and documentation
- Appeal insurance carriers on delayed or denied claims
- Medicare/Medicaid Credit balances - run report to catch monthly government credits
- MTD Summary all Visits, New Patients, Charges, Total payments, Cash Payments, Insurance payments and Adjustments.
- Year to Date Report
- Practice Stats Report
- Payment report (by charges or payments)
- Procedural Analysis Indicating Revenue Generated by each Procedure
- Diagnosis Report
- Claims Cost Analysis
- Patient referrals / Referring doctors
- Custom Report Generator: allows you to extract any information you need from the database
Remember, if you don't get paid, we don't get paid. It is to our mutual benefit to collect the full reimbursement for services rendered.
Common Medical Billing Questions
One of the heaviest questions for doctors and practice managers is whether or not they should outsource their medical billing operations or keep it in-house. Outsourcing medical billing statistically has many advantages that can help improve financial performance. Some of the top benefits include:
- Faster payments
- Improved cash flow
- Save on high equipment and software costs
- Reduced staff and related costs
- Enhanced comprehensive performance reports
- Enhanced consistency
- Reduced call volume
- Reduced payer denials
- Ability to focus on patient care instead of billing
- Patient Registration
The first step of any medical billing flow chart is patient registration. This is the collection of basic demographic patient information, including name, birth date, and the reason for the visit. Insurance information is collected and used to set up a patient file that will be used throughout the medical billing process.
- Financial Responsibility
During the second step, the patient’s insurance details and required services are covered. If there are any procedures or services that won’t be covered by the patient’s insurance they will be notified they will be financially responsible for those costs.
- Superbill Creation
During check-in, the patient completes forms for their file, or if it is a return visit, confirm or update information already on file. Identification will be requested, as well as a valid insurance card, and co-payments will be collected. Once the patient checks out, medical reports from the visit are translated into diagnosis and procedure codes by a medical coder. Then, a report called a “superbill” may be compiled from the collection of information collected. The Superbill includes provider and clinician information, the patient's demographic information and medical history, information on the procedures and services performed, and the applicable diagnosis and procedure codes.
- Claims Generation
The medical biller will use the superbill to prepare a medical claim to be submitted to the patient’s insurance company. After the claim is created, the biller reviews the information to make sure it meets payer and HIPPA compliance as well as standards for medical coding format.
- Claims Submission
After the claim is screened and approved for accuracy and compliance, it’s moved over to the submission process. During the claim submission process, it’s transferred electronically to a clearinghouse where it acts as a liaison between healthcare providers and health insurers.
- Monitor Claim Adjudication
Claim adjudication is the process by which payers evaluate medical claims and determine whether they are valid and compliant. The insurance company can decide to pay the claim in full, deny the claim, or reduce the amount paid to the provider. An accepted claim will be paid according to the insurers' agreements with the provider. A rejected claim is one that has errors that must be corrected, and the claim resubmitted. A denied claim is one that the payer refuses to reimburse.
- Patient Statement Preparation
Once the claim is processed, the patient is billed for any outstanding charges. Included in the statement are a list of services and charges, the amount paid by the insurance company, and the amount due from the patient.
- Statement Follow-Up
The last part of the medical billing process is following up to make sure the bills are paid. Medical billers follow up with bills that are unpaid and submit them to collection agencies if they remain unpaid.
If you’ve been following medical billing and coding news recently, you’re aware that some significant changes are on the way in the new year. And they’re big ones that will affect how your practice is compensated.
We’ve put together a list of the most common billing and revenue-cycle issues.
While some doctors swear by their outsourced billing service and would never consider bringing this costly and time-consuming function back in-house, others believe that using a medical billing company would deprive them of crucial cash flow control and place critical processes in the hands of strangers. Regardless of where you fall on the spectrum, a billing specialist (internal or external) must be in charge of your whole patient-to-pay revenue cycle.