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Medical Billing Articles

Best Guide to E-Visit Documentation, Coding, and Billing August 3, 2022

coding

The American Academy of Family Physicians (AAFP) encourages safe, secure online interactions between physicians and patients, such as electronic visits or “virtual e-visits.” In non-emergency situations, e-visits can substitute for office visits with primary care providers. It is a fast and easy online procedure for patients to receive a diagnosis and treatment plan.

This article will give you the best guide to e-visit documentation, coding, and billing.

What Should Providers Know About E-visits? 

An encounter must meet the following criteria to be considered an e-visit:

  • The practice must have a well-established relationship with its patients.
  • E-visits require patient consent and a communication request.
  • The patient must initiate non-face-to-face electronic communication. For example, patient portal systems.
  • Patients must not have seen an office visit to a physician or therapist for the same clinical concern in the past seven days.
  • It is only possible to report e-visits every seven days.
  • An e-visit is not the same as typical therapy sessions.

For e-visits, the following documentation requirements are needed:

  • The main complaint with all evaluation and management services (E/M).
  • The specifics of treatments, assessment of diagnoses or symptoms, evaluation, and conversation.
  • An official patient consent record is backed up by a signature and captured in the clinical note. Moreover, e-visit software platforms accept scanned copies of signed consents. Some systems allow electronic signatures.
  • The total time recorded over the seven days supporting the billable service.

List of Current Procedural Terminology (CPT) Codes That Require Providers to Follow Policies Set by Payers

The codes for online digital evaluation services (e-visits) used by doctors are complex. Below are the codes used:

Medicare uses the following HCPCS codes and descriptors for qualified non-physician professionals for its online digital evaluation service (e-visit):

Private payers and workers’ compensation are using the following online digital evaluation service (e-visit) CPT codes and descriptors:

Do’s and Don’ts in Billing E-Visits

When the following conditions are met, you can bill an e-visit:

  • The provider establishes a relationship with the patient.
  • Response time by the provider is longer than five minutes.
  • A provider responds through the patient portal to a message initiated by the patient.
  • A visit meets the 2021 E/M guidelines. 
  • It has been seven days since the clinician last saw the patient.
  • There is no global period for the same or similar condition for the patient.
  • In this case, the provider is making a clinical decision that would normally be performed in the office (e.g., medication dose adjustment, ordering a test, or prescribing a new medication).
  • A patient has consented to the e-visit and understands that he may be billed.
  • For online digital E/M services, the service period includes all related work done within seven days by the reporting individual and other registered healthcare providers (RHPs) in the same group practice.
  • The 7-day period begins when the reporting provider reviews the patient’s inquiry personally for the first time.
  • A new/unrelated problem from the patient arises within seven days of the previous E/M visit for a different issue.

Do not bill an E-visit in the following situations:

  • During the 7-day period, the provider may bill for other separately reported services (such as care management, INR monitoring, remote monitoring, etc.)
  • The same or similar condition was billed to the patient for an e-visit within the past 7 days. 
  • The patient inquires about a surgical procedure that happens during the surgery’s postoperative period (global).
  • Providers are simply disseminating results, processing medication requests, or scheduling appointments (for billing, E/M services must be performed).
  • A separate face-to-face E/M service (either in person or via telehealth) happens (included in the E/M) during the 7-day period of the e-visit.
  • Besides clinical staff time, only provider time can be included.

The AAFP published an algorithm in response to the growing number of virtual visits. It was developed by James Dom Dera, MD, FAAFP, to determine which code should be used for virtual services.

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Tips to Increase Your Clinic’s Collections August 3, 2022

patient collections

Patient collections are a constant headache for many physicians. Most clinics have difficulty collecting payments, especially if the collection process takes too long or becomes complicated. Due to this, clinics may miss payments, resulting in a reduction in income. 

For the clinic to succeed, improving the payment collection process is crucial. So, what can you do to increase your collection rate and shorten the time between payment collection and care delivery?

This article will discuss tips to increase your clinic’s collections.

Enhance the Collection Process

Reviewing current billing and collections processes can help reduce payment timelines. Patients often receive bills months after the procedure, making it less likely for them to pay. 

After the services are rendered, send out the patient’s invoice as soon as possible. Automate as much of the process as possible to shorten timelines. 

Provide e-statements and other electronic invoice delivery methods to reduce payment processing time. Furthermore, you can increase payment frequency and reduce receipt time by automating services. 

Gather payments in Advance

Patients who do not have insurance should pay on the day of their clinic appointment. This way, you won’t have to waste staff time chasing patients down for payments or establishing a payment plan after they leave. If a patient has insurance, it’s critical to remind patients about their copay obligations before the appointment. If you want, you can text them a reminder, “Don’t forget your Copay?”

Patients will know their expected copay (from the information you sourced, or it will be printed directly on their insurance identification card). They should not request you to submit the copay portion to insurance for processing instead of paying on the spot.


Manage Bills and Payments via the Patient Portal 

It can be challenging to collect patient payments. Making your payment process easy to access is the best way to ensure that your patients can pay their bills on time. To maximize revenue cycle management, providers need all the help they can get. Due to the decline of in-person appointments and payments, online payments through patient portals are becoming even more vital to the bottom line of medical practices and clinics. It not only helps practices financially, but it also helps improve patient satisfaction.

A quality patient portal should offer a fully integrated billing interface, which allows patients to view and understand their bills, ask questions, and process payments. Patients who understand their bills and payments better are more likely to pay.

Provide Payment Plans

In cases where patients are motivated to pay but cannot pay the entire bill upfront, payment plans may be a better choice. The availability of flexible payment plans will help your practice increase collections and assure patients that they can afford the treatments they require.

Patients receiving large bills and who say they can’t pay the whole amount right away may benefit from these payment plans. Ensure that your staff knows how to explain these options and track them appropriately. Payment plans should comply with all state and federal regulations. 

Prepare an Emergency Plan

Even if you implement new collection strategies to speed up payment processing, you will still experience a delay in payments. If cash flow is tight, a medical clinic still needs to be able to operate and pay its bills.

If accounts receivable are behind, a proactive cash management plan should be a backup. Fortunately, clinics and medical practices can get a healthcare business loan to fund expenses until invoices are paid. 

When you use this strategy, you can wait until the last minute to collect invoices and request only the amount you need for expenses. Improving your collection methods will allow you to require fewer loans as your clinic continues to grow. 

Invest in the Technology Systems and Software

Technology solutions can help you maximize patient collections. Examine the latest medical billing software to ensure that it contains all the features your staff needs to perform the billing process effectively.

This is a situation in which online capabilities are crucial. Since more and more patients are accustomed to doing everything online, including paying their bills, you should take advantage of that. A few clicks on the web browser are enough for them to pay their bills via the Internet.

Providing patients with easy access to bills and a quick, digital way to reimburse your practice can make a big difference in the bottom line.

In addition to letting your employees work more efficiently, technology will allow them to track how long people have owed money. This will enable them to track denied claims due to staff coding errors.

A secure email may increase the likelihood of reimbursement for a patient receiving a late payment reminder. When a paper statement gets buried in junk mail, it may not be noticed for months, resulting in payment delays.

Conclusion

Although medical practices and clinics provide a service to patients, they must view their processes from the perspective of a business. Thus, it is crucial to ensure that patients pay their invoices on time to ensure the success of your clinic.  

Tap Into Our Expertise

Feel free to contact us for assistance with medical billing and coding during this uncertain time. 

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

Schedule a call with our experts today!


2022 Coding and Billing Updates for COVID-19 Services and Testing June 29, 2022

covid testing cpt codes

Many things have changed in the healthcare industry since the emergence of COVID-19 (2019-Novel Coronavirus). Besides straining medical supplies and personnel, it also sped up the process of producing and publishing coding guidelines. 

This blog article provides a guide to 2022 coding and billing updates for COVID-19 services and testing.

When to use the cs modifier for COVID-19? 

We use modifier CS on visits related to testing for COVID-19. The latest COVID-19 billing guidelines also state that physicians can apply it to two contexts relating to coding and billing.

  • The visit could be virtual or in-person for suspected or probable exposure to COVID-19.
  • Tests for diagnosing COVID-19 without including a COVID-19 test

Let’s examine each case individually.

Suspected or Probable Exposure to COVID-19 

When billing for virtual/in-person for suspected COVID-19 exposure, you typically use the following E/M codes:

  • ICD-10 codes Z03.818, Z20.822, and Z20.828
  • Modifier CS
  • If the patient is receiving virtual care, append the modifier GQ, GT, or 95

Modifier CS can also apply for these services:

  • If the result of the service involves the order for or the administration of a COVID-19 test
  • If the service relates to delivering or administering tests
  • If the purpose of the service is to evaluate and determine if the patient needs COVID-19 testing

The cost-share will be waived through April 20th, 2021. Thus, providers need to understand that the cost-share will be waived only when they bill the correct ICD-10 code and modifier CS.

What is Modifier CR? 

It indicates whether Medicare payment for a service is subject to the Centers for Medicare & Medicaid Services (CMS) approval. As a reminder, the CMS has informed us that the CR modifier does not apply to claims recently added to the CMS list of services that may be provided by telehealth.

It is also possible to bill modifier CR or condition code DR in place of modifier CS. Also, a customer cost-share will apply to services unrelated to COVID-19.

Tests for Diagnosing COVID-19

These are the common codes used for tests relating to COVID-19:

  • ICD-10 codes Z03.818, Z20.822, or Z20.828
  • Modifier CS

These codes are used for laboratory tests in cases where COVID-19 may be suspected. These tests must be reasonable practices to rule out the presence of COVID-19.

Only the code for the panel test will be reimbursed if the COVID-19-related test is part of the laboratory panel code.

If the test is not part of a laboratory panel but rather part of a series of pathogen tests, the relevant unbundling edits may be applicable.

Source: Journal of Ahima, 2021

Monoclonal Antibody Treatment Administration for Commercial Health Plans 

  • This billing guidance applies only to urgent care facilities with an all-inclusive rate per case, per diem, per visit, and per unit.
  • We are following the place of service testing and case rate guidelines per the Centers for Medicare & Medicaid Services (CMS).
  • An in-network urgent care center must bill with the place of service 20 on a CMS-1500 form
  • Accordingly, we will pay 100% of the CMS allowable rate for the codes below.

Service: COVID-19 Testing at Urgent Care Facilities

ServiceCodes to billAdditional Information
COVID-19 testing at urgent care facilities*87635
*87636
*87811
*0240U
*0241U
*U0001
*U0002
*U0003
*U0004
*U0005
Through the end of the Public Health Emergency (PHE), COVID-19 testing at urgent care facilities will be reimbursed if billed with a COVID-19 procedure code along with one of the appropriate Z codes (Z20.828, Z03.818, and Z20.822). Whenever a health care professional bills a visit code on the same date of service as a COVID-19 testing code, the assigned medical practice will deny the testing code with remark Code: I4.
COVID-19 vaccine administration at urgent care facilities*0001A 
*0002A 
*0003A 
*0011A 
*0012A 
*0013A
Through the end of the public health emergency, COVID-19 vaccine administration will be reimbursed for in-network health care professionals if billed with the appropriate codes.
Whenever a health care professional bills a visit code on the same date of service as a COVID-19 vaccine code claim for the same patient, the assigned medical practice will deny the vaccine code.
Monoclonal antibody treatmentCodes available through Jan. 31, 2022: 

Q0220*
M0220
M0221
Q0240* 
M0240 
Q0243* 
M0243 
Q0244* 
Q0245* 
M0245 
Q0247 
M0247 (Outpatient) 


Codes available through April 5, 2022: 
• Q0247 
• M0247 (Outpatient) 
• M0248 (Home) 


Codes available after April 6, 2022: 

Bebtelovimab HCPCS code: Q0222 

Administration code: 
• M0222 (Outpatient) 
• M0223 (Home Infusion)

Evusheld HCPS Code: 
• Q0220 

Administration Code:
• M0220 (Outpatient) 
• M0221 (Home)

*These codes will price at $0 because of funds provided by the government.
Whenever a health care professional bills a visit code on the same date of service as a COVID-19 monoclonal antibody treatment claim for the same patient, the assigned medical practice will deny the vaccine code.

Newly Added Vaccine and Administration CPT Codes 2022

CPT CodeDescription
0074AAdministration, booster dose
91309Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use 
(Report 91309 with administration code 0094A) 
(Do not report 91309 in conjunction with administration codes 0011A, 0012A, 0013A, 0064A) 
Moderna
0094AAdministration, booster dose
91310Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, monovalent, preservative free, 5 mcg/0.5 mL dosage, adjuvant AS03 emulsion, for intramuscular use 
(Sanofi Pasteur)(Report 91310 with administration code 0104A)
0104AAdministration, booster dose

New Guidelines for Outpatient Services Under COVID-19 Cost Share Waiver

Use the CS modifier on appropriate outpatient claim lines for services provided through the end of the Public Health Emergency (PHE). This illustrates that the service is eligible for a cost-share waiver for COVID-19 testing-related services contracted for and related to the provision or administration of a COVID-19 test. 

Providers will receive a waiver of cost-share when they: 

  • Submitting a claim line with CS modifier (professional, facility, telehealth) with a specific outpatient E&M or HCPCS code and when billed of probable or suspected exposure to COVID-19: ICD Z20.822 as the primary diagnosis, as needed.
  • Submits a COVID-19 CPT/HCPCS claim line testing for preoperative procedures. 
  • Z01.810 – preprocedural cardiovascular examination 
  • Z01.811 – preprocedural respiratory examination 
  • Z01.812 – preprocedural laboratory examination 
  • Z01.818 – other preprocedural examination
  • For each additional lab test other than the COVID-19 diagnostic test, a CS modifier must be added to each claim line. If the lab test was ordered specifically to determine a diagnosis of COVID-19 and if billed with probable or suspected exposure to COVID-19, a primary diagnosis of Z20.822 should be put forth.
For Billing Guidelines
Dates of service on or after March 1, 2020, and for the duration of the PHEEffective January 1, 2022 

The POS 02 description was revised and a new code, POS 10, was developed. The place of service billed is dependent on where the patient is located during the telehealth service. When billing for telehealth services, use: 

POS 02: Telehealth Provided Other than in Patient’s Home 
Patients are not located in their homes when they receive health services or related services via telecommunication.

POS 10: Telehealth Provided in Patient’s Home 
In the case of receiving health services or health-related services via telecommunication, the patient is located at home (other than a hospital or other facility where they receive care in a private residence).

We hope that this guide to COVID-19 updates in coding and billing for 2022 has been useful to you. Visit the American Medical Association (AMA) for more information on COVID-19 codes, services, and vaccine updates.

Tap Into Our Expertise

Feel free to contact us for assistance with medical billing and coding during this uncertain time. At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

Schedule a call with our experts today!


New CPT Codes for Digital Therapies and Telemedicine June 29, 2022

digital cpt codes online

Physicians can now administer safe treatments to non-COVID and COVID patients using telemedicine. Also, it enables small health care practices to remain in business and even extend the services they offer. 

With this new technology, patients can easily schedule appointments, view their medication histories, and communicate with their doctors. Telemedicine will continue to enhance remote health care for many years to come. 

Meanwhile, accurately tracking telehealth reimbursements can directly impact the bottom line of your health care practice. Our new list of CPT codes for digital therapies and telemedicine helps you facilitate better management of telehealth billing.

CPT Codes for Telemedicine/Telehealth

The following codes are commonly reported for Medicare patients:

CPT Codes for Telehealth VisitsDescription of Service
99201-99205Office/outpatient evaluation and management (E/M) visit, new
G0425 – G0427Consultations, emergency department, or initial inpatient (Medicare only)
Virtual Visit/Check-Ins CPT CodesDescription of Service
CPT Code G2010Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
CPT Code G2012Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

In addition, the Centers for Medicare & Medicaid Services (CMS) created two additional G codes for billing by practitioners who cannot independently bill for E/M services. G2250 and G2251 are CPT codes billable by a selected group of nonphysician practitioners based on their benefit categories.

HCPCS G CodeDescription of Service
G2250Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous seven days nor leading to a service or procedure within the next 24 hours or soonest available appointment.
G2251Brief communication technology-based service, e.g., virtual check-in, by a qualified health care professional who cannot report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to a service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
G2252 (CMS permanently establishes separate coding and payment for the extended virtual check-in service, G2252, effective January 1, 2022.) The reimbursement amount has been cross-walked to the reimbursement for Current Procedural Terminology (CPT) code 99442.Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion.

Telephone Evaluation & Management (E/M) Services

CPT codes for telephone E/M are time-based. In addition, payments for telephone E/M services CPT codes 99441-99443 are equivalent to 99212-99214 and can be used for new or established patients during the Public Health Emergency (PHE). Modifier 95 should be applied, and the place of service (POS) should be where the visit would have taken place in person before the public health emergency (e.g., 11-Office, 22-Hospital Outpatient, 23-ASC). Before reporting codes for non-Medicare beneficiaries, ensure that your commercial payers cover these services.

CPT Code 99441For any new or established patients, telephone or audio-only evaluation and management services cannot originate from a related E/M service provided within the previous seven days nor lead to an E/M service or procedure within the next 24 hours or as soon as the earliest available appointment, 5-10 minutes of medical discussion.
CPT Code 9944211-20 minutes of medical discussion
CPT Code 9944321-30 minutes of medical discussion
Currently covered by Medicare and some Medicaid programs on an interim basis*
E-VisitsDescription of Service
99421 – 99423 Online digital evaluation and management service, for an established patient, for up to 7 days, a cumulative time during the 7 days
G2061 – G2063Online assessment by qualified non-physician healthcare professional
Interprofessional Telephone/Internet/EHR ConsultationsDescription of Service
99446 – 99449Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional
*Each code includes time for medical consultative discussion and review
99451Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time
99452Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/ requesting physician or other qualified healthcare professional, 30 minutes

HCPCS LEVEL II CODES

HCPCS Level II codes for telemedicine services are also available for reference.

HCPCS Level II Telehealth CodesService
G0406-G0408Follow-up Inpatient Consultation via Telehealth
G0425-G0427Telehealth Consultation, Emergency Department
G0508, G0509Telehealth Consultation, Critical Care
Note: CPT Copyright 2021 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.

On the CMS website, you can find a list of all the available codes for telehealth services.

Tap Into Our Expertise

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

Schedule a call with our experts today!


Mental Health Billing: Tips and Guidelines June 9, 2022

mental health billing

As a mental health provider, your goal is to provide the best care to your clients. It also plays a vital role in maintaining people’s well-being and healing their emotional wounds.

Insurance companies must be able to reimburse you promptly for services you rendered. 

However, there are often issues with mental health billing that can hinder the treatment process, such as inaccurate documentation or preauthorization. Mental and behavioral health providers may stumble upon one or more of these problems – and many others – which make it hard to run their practice effectively.

For instance, filing medical billing claims for mental health services takes too much time from patients. 

Thus, understanding the billing process’ complexities and finding ways to solve them can speed up the billing process and help you get paid faster for providing behavioral health services. Take this as a refresher course in mental health billing for dummies.

Throughout this article, you will learn the right mental health billing tips and guidelines.

Tips in Billing for Mental Health Services

While mental health billing isn’t easy, it can certainly be achieved with the right strategy and skill set. 

Here are some tips to help mental health practices bill for services more effectively, with more funds, more time for patients, and fewer denials. 

  1. Verify the Coverage and Insurance of Every Patient

The first tip is to know your patient’s insurance plans and benefits before each visit. However, making sure you understand the coverage available for each patient before receiving any services will lead to a larger return. 

While validating coverage may take much time, it pays off because you can ensure your client is covered and determine how much the insurer is likely to pay. Depending on the insurance company, you can verify coverage online or by phone. Verification of benefits (VOB) is also an excellent way to know what range your prospective patients have before they are treated.

It’s always best to check benefits before the first session and re-validate at the start of the year when coverage renews or if your client’s insurance changes.

  1. Know Your Common Procedural Technology (CPT) Codes

The American Medical Association (AMA) publishes and maintains the Current Procedural Terminology (CPT) code set. Most insurance payers use CPT codes to determine whether they will reimburse claims. You should use the correct codes for the services and stay up-to-date on the updates, which occur yearly. In this way, you can guarantee that the codes match the preauthorization, if applicable, and that you do not under-code or up-code. 

Below are the three most common mental health CPT codes:

  • 90791 – Intake session — to be billed for your first appointment with that patient exclusively
  • 90834 – 45-55 Minute Individual Therapy Session
  • 90837 – 56+ Minute Individual Therapy Session

  1. Pre-authorize When Necessary

In most cases, insurers don’t require preauthorization for initial visits or basic behavioral health sessions. In some instances, various payers have different rules (e.g., over 45-minute sessions or multiple sessions for one client in a day). When you start working for a new client, always check if preauthorization is required before providing any non-standard session.

  1. Learn How to File Claims Properly

For reimbursement on a claim, you have to file the correct claim code with the right insurer and submit the claim along with the correct billing format. Insurance companies may differ in this regard. If the insurance company has a preferred filing method, make sure you comply with it and the time frame set forth by the insurer. 

Most major insurance companies use the UB-04 claim form for specialized health centers such as mental health and rehabilitation clinics, so familiarize yourself with this form. 

You can fill out the UB-04 electronically or on paper, and several software programs have a current version of the form and instructions on how to complete it. Thus, ensure that your claim is properly filed to spend less time on it.

Guidelines to Make Your Mental Health Billing Process Easier

1.Electronic Health Record Software

To input the data and create the forms, you can try using a pure software solution, such as an EHR (electronic health record). It allows you to create and submit electronic claims easily. EHRs come with calendaring, appointment reminders, simplified documentation, internal messaging, a patient portal, and credit card processing. Look for an EHR explicitly tailored to the behavioral health providers.

2. Hire an Outsourcing Company for your Mental Health Billing Services

If you want to focus on providing healthcare rather than processing claims, you can hire a billing company to handle your claims. They can manage a variety of tasks for you. Aside from billing and claims submission services, some outsourcing billing companies also take care of prior authorization, VOB, claim denials, and follow-ups. 

Tap Into Our Expertise

We handle every aspect of billing for you!

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

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What to Expect from New Pain Management Coding Updates and Guidelines 2022 May 3, 2022

pain management cpt code

The ability to understand medical terminology has always been an essential requirement for medical coders. To better understand the language of the new codes, they should review anatomy and physiology terms.

Troubleshooting is another important recommendation for ICD-10-compatible software and computer formats. This knowledge will assist healthcare providers in resolving any technical problems in time. Thus, healthcare providers must be aware of the potential impact of coding system changes on existing and new insurance programs.

In this article, we’ll find out what to expect from new pain management coding updates and guidelines 2022.

Pain Management Coding Updates 2022

As of 2022, two CPT codes have been deleted and replaced with new ones that provide more detail about procedures.

01935— (Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic)
01936—(Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic) are deleted in CPT®2022.

Moreover, the new codes 01937-01942 identify the type of surgical procedure performed under anesthesia and whether it’s done on the cervical, thoracic or lumbar spines.

New CPT codes for 2022

In the table below, you can refer to the  new CPT code changes for 2022 applicable to anesthesia and pain medicine:

01937Anesthesia for percutaneous image-guided injection, drainage, or aspiration procedures on the spine or spinal cord; cervical or thoracic
01938Anesthesia for percutaneous image-guided injection, drainage, or aspiration procedures on the spine or spinal cord; lumbar or sacral
01939Anesthesia for percutaneous image-guided destruction procedures by a neurolytic agent on the spine or spinal cord; cervical or thoracic
01940Anesthesia for percutaneous image-guided destruction procedures by a neurolytic agent on the spine or spinal cord; lumbar or sacral
01941Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; cervical or thoracic
01942Anesthesia for percutaneous image-guided neuromodulation or intravertebral procedures (eg, kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral
64628Thermal destruction of the intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral
64629Thermal destruction of the intraosseous basivertebral nerve, including all imaging guidance; each additional vertebral body, lumbar or sacral (List separately in addition to code for primary procedure)
933193D echocardiographic imaging and postprocessing during transesophageal echocardiography, or transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) (eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (List separately in addition to code for echocardiographic imaging)
These codes and other information you need to know for coding/billing in 2022 are copyrighted by American Medical Association.

Likewise, we’ll discuss some other commonly used pain management CPT codes. These include acupuncture, dry needling,  and radiofrequency ablation.

Acupuncture

In accordance with NCD 30.3.3, Medicare now covers all types of acupuncture as a treatment for lower back pain. Patients with chronic lower back pain can receive acupuncture treatment for up to 12 sessions within a 90-day period through Medicare.

The purpose of acupuncture is to relieve pain and restore energy flow by inserting tiny needles through the skin. According to the National Center for Complementary and Integrative Health Trusted Source, acupuncture effectively treats back pain, osteoarthritis, and knee pain. Furthermore, it stimulates the body’s natural healing processes and promotes health and happiness.

Acupuncture CPT Codes

97810— Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97811—Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles
97813—Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
97814—Each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needles

Acupuncture data is reported based on 15-minute increments of personal contact (face-to-face) with the patient, not on the intensity or duration of the acupuncture treatment.

  • When electrical stimulation is not used during a 15-minute increment, report CPT codes 97810 or 97811.
  • Electrical stimulation of any needle during a 15-minute increment are reported by using CPT codes 97813 or 97814.
  • For each 15-minute increment, you should report only one code
  • Use CPT code 97810 or 97813 for the initial 15-minute increment
  • Each day you should only report one initial code

Dry Needling

The following CPT codes are used for dry needling, which is also known as trigger point acupuncture.

20560—(Needle insertion(s) without injection(s); 1 or 2 muscle(s)
20561—(Needle insertion(s) without injection(s); 3 or more muscles)
20551—Origin or insertion of a tendon is injected
20550—Injection of the tendon sheath

The Current Procedural Terminology specifies that CPT codes 20552 or 20553 (trigger point injections) must not be reported with CPT codes 20560 or 20561 for the same muscle group.

Radiofrequency Ablation

The radiofrequency ablation (RFA) procedure involves delivering an electric current to a small nerve tissue area to prevent pain signals from being transmitted through that area. It can relieve chronic pain, specifically in the lower back, neck, and arthritic joints. 

These are the RFA CPT codes 2022:

64625— Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography)
64999—Unlisted procedure, nervous system
  • If radiofrequency ablation is used with traditional or cooled radiofrequency (80 degrees Celsius), report it with CPT code 64625.
  • Report pulsed radiofrequency ablation by using CPT code 64999.

CPT Code Changes for Important Diagnoses

  • C56.3 Malignant neoplasm of bilateral ovaries (previously only left, right, unspecified existed)
  • C79.63 Secondary malignant neoplasm of bilateral ovaries (previously only left, right, unspecified existed)
  • G44.86 Cervicogenic headache
  • K22.81 Esophageal polyp
  • K22.82 Esophagogastric junction polyp
  • K22.89 Other specified diseases of esophagus (previously codes as K22.8, 5th character added)
  • K31.A—Gastric intestinal metaplasia (code to appropriate 6th character)
  • L24.A- Irritant contact dermatitis due to friction or contact with body fluids (code to appropriate 5th character)
  • L24.B- Irritant contact dermatitis related to stoma or fistula (code to appropriate 5th character)
  • M54.A- Non-radiographic axial spondyloarthritis (code to appropriate 5th character)
  • M54.50 Low back pain, unspecified
  • M54.51 Vertebrogenic low back pain
  • M54.59 Other low back pain

Any ambulatory surgical centers performing pain management procedures need to be aware of these low back pain diagnosis changes. In order to avoid an unspecified diagnosis, surgeons must understand how the revisions affect their documentation. They must be as specific as possible about the type of low back pain treated.

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Medical coders might face some new challenges in light of the new pain management billing codes and guidelines. As a result, healthcare providers should evaluate how medical coding changes will affect their programs and take steps to ensure a smooth transition.

At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

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Podiatry CPT Coding Updates for 2022 April 27, 2022

podiatry cpt coding

Every year, the American Medical Association releases a new Current Procedural Terminology set that takes effect on January 1.

Most of this year’s changes come from new guidance language rather than code additions, deletions, or edits for podiatry practices. Let’s first define podiatry care in detail before moving on to the CPT updates.

The Role of Podiatry in Healthcare

The field of podiatry deals with the diagnosis and treatment of diseases, injuries, and deformities of the foot. It involves the diagnosis, medical, and surgical treatment of the foot, ankle, and lower extremity problems. In addition to medical and surgical treatments, mechanical and physical therapies are also available. Like other disciplines, podiatry requires regular collections to survive.

On the other hand, coding is complex in podiatry due to multiple procedures performed on the same structure or organ, requiring various codes.

The Current Procedural Terminology adds the following clarification for 2022: “All services that appear in the Musculoskeletal System section include the application and removal of the first cast, splint, or traction device when performed. Supplies may be reported separately.” 

Several third-party payers, such as Medicare, have long followed this guidance, which applies everywhere CPT codes are used, regardless of the payer.

This guidance does not change based on where you receive your services. If the triple arthrodesis is performed in the operating room, the CPT code representing the cast application should not be submitted.

Similarly, suppose any fracture care code is submitted in an office setting, such as closed fracture treatment without manipulation. In that case, the CPT code corresponding to the cast application should not be submitted.

Podiatrists managing fractures often have to decide whether to perform closed treatment with manipulation or closed treatment without manipulation CPT codes.

The new language in the 2022 CPT code set clarifies what “manipulation” actually means when used in code descriptors in CPT. Manipulation is defined as: “reduction by the application of manually applied forces or traction to achieve satisfactory alignment of the fracture or dislocation.” Usually, this is referred to as closed reduction.

The CPT clarified the following codes for external fixation this year:

“Codes for external fixation are reported separately only when external fixation is not listed in the code descriptor as inherent to the procedure.”

Therefore, providers can only submit external fixation CPT codes. CPT does not include the application of external fixation in its code descriptor for the primary procedure.

Below is the CPT code corresponding to a first metatarsophalangeal joint arthrodesis:

CPT 28750Arthrodesis, great toe; metatarsophalangeal joint

Code descriptor doesn’t include external fixation in the list. Hence, the CPT code for the first metatarsophalangeal joint arthrodesis and the CPT code for the external fixation can both be submitted if external fixation is used. 

In the case of an open reduction and internal fixation (ORIF) of a metatarsal fracture that is fixed with external fixation, the CPT code for the external fixation would be:  

CPT 28485Open treatment of metatarsal fracture, with or without internal or external fixation, each

This is listed in the code descriptor. Thus, if external fixation is used with this procedure, only the ORIF CPT code can be submitted; the external fixation CPT code cannot be submitted as well.  

Foreign Body vs Implant 

If a joint prosthesis becomes loose or isn’t functioning, is it considered a foreign body removal? The CPT clearly answers this question that has been asked for a while now. 

According to the new language on page 525 of the CPT book for 2022, it states that:  

 “An object intentionally placed by a physician or other qualified health care professional for any purpose (eg, diagnostic or therapeutic) is considered an implant.”

“An object that is unintentionally placed (eg, trauma or ingestion) is considered a foreign body.”

“If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes, unless CPT coding instructions direct otherwise or a specific CPT code exists to describe the removal of that broken/moved implant.”

Wound Repair

This year, a new language adds that only one CPT code is required to represent the closure of one wound when multiple products and/or multiple techniques are used to close it. 

Further information on wound repair is provided in the 2022 CPT book, on page 106, where it is stated that wounds treated with chemical cauterization, electrocauterization, or adhesive strips cannot be coded with wound repair CPT codes.

Clarification of simple wound repair is on the list this year:

“Simple repair is used when the wound is superficial (eg, involving primarily epidermis or dermis, or subcutaneous tissues without significant involvement of deeper structures) and requires simple one-layer closure.”

Moreover, anesthesia and hemostasis should not be reported separately when combined to treat simple wounds.

Key Takeaway

These are just a few changes relevant to podiatrist practices in 2022’s CPT codes. The podiatry providers who submit CPT codes should know the entire CPT code set or use experts who are familiar with it. From January 1, 2022, they should utilize the most current CPT code set.  

The CPT is a trademark of and copyright (2021) of the American Medical Association, with all rights reserved. 

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What Is Quality Payment Program (QPP)? March 25, 2022

QPP meaning

What is the Quality Payment Program (QPP)?

A vital element of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was the elimination of the Sustainable Growth Rate (PDF) (SGR) formula, which would have led to lower physician payments.

MACRA wants to speed up the transition to a health care system that rewards quality and value rather than volume and improves patients’ health outcomes. Under the new QPP, Medicare reimbursement will undergo the most significant change in decades.

Clinicians have two options for participating in the Quality Payment Program:

  1. The Merit-based Incentive Payment System (MIPS): A performance-based adjustment will be made if you qualify MIPS requirements.
  2. Advanced Alternative Payment Models (APMs): Medicare may reward you for participating in innovative payment models if you take part in an Advanced APM.

Overall, QPP provides an opportunity to drive true health system reform that results in patient- and family-centered care. Thus, this will ensure success in the long run. The Centers for Medicare & Medicaid Services (CMS) expect the Quality Payment Program to evolve. The rule will allow a 60-day comment period to solicit more input from clinicians, patients, and others.

With the new Quality Payment Program website, clinicians can identify the measures and activities most relevant to their specialty or practice. Clinicians and practice managers can use this tool to find the program that best fits their needs.

In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, repealing the Sustainable Growth Rate (SGR) payment system which governed how physicians and other clinicians were paid under Medicare Part B. MACRA replaced the SGR, and its fee-for-service reimbursement model, with a new two-track value-based reimbursement system, called the Quality Payment Program (QPP). This program is the latest in a series of steps the Centers for Medicare and Medicaid Services (CMS) has taken to incentivize high quality of care over service volume.

With the Quality Payment Program, Medicare providers will be paid according to their quality and value.

The MACRA reinstated the Sustainable Growth Rate (SGR) for Medicare payments, thus providing providers with annual payments with a sense of stability. From 2019, payment to health care providers will be tied to either the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). These two tracks make up the Quality Payment Program (QPP).

In 2017, providers will begin reporting QPP performance data, and payment adjustments will start in 2019. Taking time between reporting performance data and making payment adjustments allows adequate time for submission and feedback. As part of the first reporting year, providers will be able to decide how much data to report.

Moreover, the implementing rule for QPP explains how Medicare providers will be reimbursed under both payment systems. While the Centers for Medicare & Medicaid Services (CMS) works with different stakeholders to implement and develop new rules, the requirements for providers are likely to change.

What is a Merit-Based Incentive Payment System?

A key aspect of MIPS is that it builds on the conventional fee-for-service Medicare model while rewarding providers for delivering quality care and improving health outcomes. Even though most Medicare providers will be in MIPS when the program starts, the law intends for them to switch to APMs. So, it opens the way for the healthcare industry to transition from fee-for-service to value-based care.

MIPS evaluates providers in four performance categories: 

  1. Quality. The Quality category will comprise existing Medicare quality reporting programs (including the Physician Quality Reporting System). For 90 days, most providers will report on six quality measures, including one outcome measure, from more than 200 measures. The traditional rulemaking process will define and develop additional evidence-based measures for MIPS, emphasizing outcomes-based measures over time. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS allows providers to get bonus points for reporting on patient experience measures.
  1. Cost. CMS will incorporate the existing Medicare Value-Based Payment Modifier into its cost category. In this way, the modifier provides differential payment based on the quality of care provided compared to the cost. The cost measures are derived from claims data; CMS does not require providers to supply additional data for scoring purposes. This year, the Cost category will weigh 0%, so it will not count towards the MIPS Final Score. CMS says this category’s weight will increase in future MIPS performance periods.
  1. Advancing Care Information (ACI) is the replacement of the Medicare EHR Incentive Program (Meaningful Use). Clinicians’ use of EHR technology will be judged under this category, focusing on interoperability and information sharing. ACI will make up 25% of an eligible clinician or group’s final MIPS score in 2017.
  1. The new performance category is Improvement Activities. The program offers a broader set of activities and rewards to clinicians that focus on beneficiary engagement, care coordination, and patient safety. For MIPS, most providers must complete at least two to four activities for at least 90 consecutive days, depending on their weighting. Furthermore, providers who participate in a patient-centred medical home (PCMH) qualify for the highest score for clinical improvement activities. However, providers enrolled in APMs (that are not PCMHs) will receive half the points toward full credit in this category. There may be some providers eligible for full credit in APMs.

What is an Advanced Alternative Payment Models (APM)?

By taking new payment models one step further, Advanced APMs are payment models in which the organizations share the savings gained from offering high-quality care at low costs while often assuming the downside risk if the care is actually more expensive than the plan.

In an Advanced APM, providers receive an automatic five percent bonus a year. The APM may also give them bonuses or penalties, such as shared savings or losses within an Accountable Care Organization (ACO). 

Among the advanced APMs are:

  • Medicare Shared Savings Program (tracks 2 and 3)
  • Oncology Care Model (OCM)
  • Primary Care First (an evolution of CPC+)

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How to Code for Obesity and Medical Nutrition Therapy March 25, 2022

CPT code for Nutrition and Obesity

The National Institutes of Health (NIH) declares that obesity is a significant public health concern in the United States. Obese individuals are at higher risk of developing heart disease, strokes, and cancer. Furthermore, the number of obese people worldwide has increased from 26 million in 1975 to 422 million. 

Not everyone knows that genetics, environmental, and metabolic factors can contribute to obesity.

We will outline the proper way to code for obesity and medical nutrition therapy (MNT) for healthcare providers.

Coding Medical Nutritional Therapy

The obesity treatment can range from therapy to surgery. It is evident that surgery should be a last resort and only be considered for severely obese individuals. Meanwhile, the following list below contains medical nutrition therapy code(s) that dietitians use. Private insurance carriers, besides public insurers, such as Medicare and Medicaid, can also use these MNT CPT codes.

Passing the midpoint constitutes a unit of time. The billing process for codes 97802 and 97803 would take eight minutes. You can bill a maximum of eight units per code for the same patient on the same day. If a healthcare provider spends 22 minutes with a patient, they can only bill 97802 or 97803 once since they’ve not reached the midpoint of the next 15 minutes.

Code 97804 follows the same rules as MNT CPT codes 97802 and 97803. However, the code 97804 is for 30 minutes each. To bill the first unit of 97804, you must spend at least 16 minutes with the patient. For the second unit, you must spend 46 minutes, and so on. Consider consulting an expert in coding if you find this issue troubling.

You should refrain from making only one common mistake: reporting these sessions as incident-to. That’s why it is not a good idea to report 97802-97804 incident-to-a doctors since they are nutritionist-specific codes. Make sure to use the nutritionist’s national provider identifier. 

The modifier AE Registered dietician can be added to the MNT code. For clarification, this modifier denotes the services of a nutritionist or registered dietitian. Several insurers, including Medicare, may have a policy regarding the frequency of MNTs and how many visits a patient can have. If applicable, check the payer’s policy and require the patient to sign an advance beneficiary notice (ABN).

The dietitian (or qualified nutritionist) reviews the patient’s diagnosis and treatment plan in their changing medical condition. In addition, their job is to perform a nutrition screening and discuss the patient’s specific dietary needs. Including telehealth services, the provider spends 15 minutes with each patient discussing long-term healthy eating. For this reassessment and any subsequent interventions, report this code every 15 minutes. The first year of medical nutrition therapy consists of only three one-on-one sessions.

The rules apply in the same way with the MNT CPT code G0270. However, in a dietitian-led therapy session, there must be at least two people (e.g., a group).

The CPT Codes for Weight Loss and Obesity Screening 

CPT 99401

Description: Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 15 minutes.

CPT 99402

Description: Preventive medicine counseling and/or risk factor intervention/s provided to an individual (separate procedure); approximately 30 minutes.

CPT G0446

Description: Annual, face-to-face intensive behavioral counseling (IBT) for cardiovascular disease (CVD), individual, 15 minutes.

CPT G0447

Description: Face-to-face behavioral counseling for obesity, 15 minutes.

CPT G0473

Description: Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes.

Codes for Body Mass Index (BMI) Z68.XX

Obesity codes:

Clinicians usually obtain a patient’s BMI while they take their vital signs. The provider needs to code the patient’s BMI with the appropriate obesity code in such cases.

On the other hand, ICD-9 CM 278.00 is a billable medical code that indicates a diagnosis on a reimbursement claim, but it should only be used on claims with a service date before September 30, 2015.

Summary

Since it’s easy to get unhealthy foods and there are fewer healthy options available in many places, obesity is likely to remain a nationwide issue. While making the right choices for ourselves, we can also counsel our patients on doing the same.

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Tips for Successful Neurology Billing and Coding February 16, 2022

Neurology Billing and Coding

Neurology practices face challenges because of inaccurate billing and coding. Documentation requirements are specific and complex, which burdens clinicians significantly. That’s why neurology medical billing and coding must be accurate to ensure proper claim settlement and payment.

Don’t worry about it! Here, this article will help you with tips for successful neurology billing and coding.

An Overview for Neurology Medical Billing & Coding Services

Neurology deals with disorders, diagnoses, and treatments of the nervous system. It covers both central and peripheral nervous system diseases.

Neurologists and neurosurgeons treat nervous system diseases either with surgery or non-surgery. In covering more than one aspect of neurology, they demonstrate an incredible level of expertise and attention to detail. Neuromuscular, sleep, stroke, and epilepsy are a few areas that neurologists can handle.

Coding and billing in neurology require a great deal of detail. In a sense, it’s like an extension of Evaluation & Management.

On the other hand, over a hundred codes are available for coding neurology and neuromuscular tests. That’s why coders have a tough time applying the correct code.

Furthermore, billing & coding experts in neurology should be familiar with the codes and rules specific to the field. This is because neurologists see patients in various settings like hospitals, clinics, and offices. Only a company with experts in neurology billing can handle such complexity.

For neurologists, broad and deep expertise are the keys to successful billing. These include collecting all of the money owed to the neurosurgeon, responding to queries from payers, and appealing denied claims.

Check Out These Useful Tips for Successful Neurology Billing and Coding

Courtesy Makes Communication Effective

Medical billers and coders don’t work behind closed doors. These professionals are likely to interact with patients, insurers, third-party vendors, and other stakeholders in the healthcare system. Even so, some of them may find discussions to be challenging.

For example, frustration could arise if the claim isn’t processed or is in process. Therefore, billing and coding teams must always remain courteous with all people they work with, as they act as a ‘bridge’ between insurance companies, physicians, and patients.

Regular Training of Staff Is Important

Your staff needs to be trained in the latest practices for claims settlements to be faster. Be sure it’s being done according to plan so that they are ready to service the needs of patients. If possible, training should be uninterrupted. By training the staff in the fee-for-value model, they will understand how to increase patient satisfaction in the practice.

Verify Patient Benefits

Neurology practices should verify all patient copayments, coinsurance responsibilities, and deductibles before treatment. The registration process should also confirm any necessary approvals and procedures.

Likewise, neurologists must maintain accurate records and medical histories so that timely counseling can occur and reimbursements can be timely processed. It is also essential to follow up on patient prescribed tests and monitor outstanding accounts.

Pay Attention to Details

In neurology medical billing, coders use thousands of different medical codes for various procedures. While it is unrealistic to expect a person (or medical coder) to know every medical code, they should be familiar with where the most common ones are located. Remember that careless errors may delay payment processing and, eventually, cause the payment to be delayed or denied.

Comply With HIPAA

The healthcare professionals also constantly work with the billing department and the patient’s health information. In fact, the (Health Insurance Portability and Accountability Act) HIPAA obligates these professionals to protect patients’ privacy in these cases. For medical billing companies to succeed, they must possess sound judgment and operate with the highest levels of reliability.

Implementation of the ICD-10 Coding System

ICD-10-CM provides greater clinical detail, better specificity, and relevance for managed care and ambulatory encounters. To prevent delays in settling claims, ensure that your coders, billers, and practice staff are up-to-date with the latest codes (including ICD-10) and CPT codes. It will also ensure error-free billing and accuracy in records for future inspections.

Partner With a Reliable Medical Billing Company

By partnering with a reliable billing company, you can eliminate billing errors. Their staff consists of billing experts, who are under their command. They also utilize automation and work with all major health insurance carriers. With them, you can focus more on your patients and reduce the administrative burden.

Coding Levels Should Be Precise

For each patient, it is crucial to use the correct coding level to prevent cloning claims. The coding level should correspond to the level of illness. Otherwise, an audit can result if billing is done for all patients at the same level.

Key Takeaway

In the United States, many neurologists opt to outsource their neurology billing and employment services to overcome payment-related challenges. Our goal at 5 Star Billing Services is to increase revenues, decrease denials, and improve and automate your entire revenue cycle.

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Here’s your chance! At 5 Star Billing Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

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