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Denial Management and Prevention Tips for Your Medical Practice November 23, 2020

denial management

Denied claims eat away 6-8% of a healthcare provider’s overall revenue. It hampers the financial stability and the growth of a practice. Contrary to popular belief, 90% of denied claims are actually preventable. You just need to take your denial management and prevention to the next level. We’ve gathered the best tips to stop these revenue leaks: 

1. Monitor you progress.

First, assess your denial management process frequently. You need to discern what’s working and what areas need improvement. To know your progress, you need to document all wins and losses for your unpaid claims. Thus, you’ll be able to use that data to improve the efficiency of your denial management strategies. 

2. Recognize why claims were rejected.

Understanding the causes of your denied claims will help streamline the process of maximizing your revenue collections and prevent the denial of future claims. Not all of your patients are knowledgeable about when their claims are being denied by insurance companies. Thus, it is your responsibility to educate them when tackling the issue. In connection, It is also important for the overall performance of your company to be able to assist them in a timely manner.

3. Identify the most common denials and trends.

Try to identify the types of denials that are most common to your organization. Initially, each form of denial can seem like a minor issue, but when you begin to track and examine these patterns, it can lead you to the root cause of some major problems in your organization.

4. Establish Incentive Programs

To motivate and encourage healthy competition, rewards and incentives should be put in place. Your staff should have the right motivation not only to successfully appeal denials but to recognize trends, share knowledge, and have great camaraderie.

5. Expedite your Denial Management Process

Denied claims may pile up over time and it may easy to lose track, which may lead to serious problems in the future. Utilize the latest technologies and tools that help you keep track, manage, and expedite your denial management processes. 

6. Do it within a week

You need to set high standards for timeliness in processing your denied claims. An effective tracking system would lead to more efficiency and help impact all factors of your practice. If you get a rejection from an insurance provider, there must be a procedure in order to ensure that the denial is handled in less than a week.

7. Leave it to the experts

You can never go wrong in outsourcing your medical billing and denial management processes to a trusted name in healthcare. It will surely give you the financial prosperity and stability that you always desired. Specialized teams that are highly trained in handling the complexities of the insurance system are used by the top denial management providers. You’ll have more time to focus on your core competencies by outsourcing your denial management needs.

Tap Into Our Expertise

At 5 Star Medical Billing, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times.

Schedule a consultation with our experts today!


How COVID-19 Is Changing the Medical Billing Process November 19, 2020

medical billing process

The pandemic continues to overwhelm the globe. Economies are in a recession. And hospitals and private practices throughout the United States are absorbing a lot of the brunt. They are barely holding on due to the decline of outpatient and non-urgent treatment procedures. In addition, the pandemic also brought a lot of changes in medical billing. Thus, adapting to your practice’s survival has never been more critical. 

How Medical Practices are Thriving

The Inbox Health Survey reports that 21% of 1200 medical billers forecast that 10-25% of their practices may shut their doors for the next six months. Luckily, over $100 billion has been provided by the US Congress to help medical practices, hospitals, doctors, and other healthcare professionals through the Public Health and Social Services Emergency Fund. However, many fear that it may not be enough.

Changes in Patient Interactions and Collections

Most of the 1,200 Inbox Health Survey respondents observed a great decline in their patient volume and interactions. Subsequently, it results in a 10% to 25% drop in collections. It intensifies the struggle to survive and cope in the middle of a global pandemic and recession. 

How to Cope with the Medical Financial Crisis

The following are the vital keys that you need to consider to cope and survive and achieve financial sustainability amidst the pandemic:

  1. Adjust operational accommodations
  2. Record changes in standard referral requirements
  3. Adapt to the rapidly changing rules and regulations in billing and coding, especially with Medicare and Medicaid.
  4. Take note of the following questions regarding Telehealth: 
  • The total sum of coverage
  • Extra documentation for medical necessity
  • Prior authorizations and required approvals
  1. Tighten remote medical billing plans to minimize cash flow issues
  2. Account for changes in copays and deductibles
  3. Optimize your resources according to a surge or drop in patient volume

How to Adapt Effectively to the Changes

For healthcare organizations struggling to cope with the pandemic, it is vital to keep their facilities open and to improve their medical billing operations. The Strata Decision Technology reported a massive drop in inpatient procedures at the start of the pandemic. Here are some keys to generating revenues and rebuilding financial capacity: 

  • Provide telehealth services
  • Implement s safe social distancing plan in the clinic
  • Adapt innovative healthcare technologies like telemedicine
  • Gain the patient’s trust and confidence
  • Secure necessary supplies for a patient surge
  • Conduct strict precautionary measures in the clinic

Telemedicine’s Role in the New Normal

Telemedicine services and technologies have been the greatest help in medical advances in health care due to the pandemic. It played a great role in keeping healthcare organizations afloat and lowering the risk of infection for patients. Undoubtedly, it will continue to do so in the post-COVID era. The CMC even reports that telemedicine catered to over 9 million patients during the first few months of the pandemic.

Telemedicine technologies made it possible for healthcare facilities to provide safe treatments to non-COVID and COVID patients. It enables small practices to continue their operations and even extend the lengths of their services. Patients can easily book their consultations online. It opened new gates of healthcare convenience, proving to the world that it is not just a mere temporary aid for the pandemic. Hopefully, it will continue to widen the scope of remote services well into the future. 

Tap Into Our Expertise

At 5 Star Medical Billing, we offer the highest level of performance for high-quality medical billing. Let us help you during these dire times.

Schedule a consultation with our experts today!


Increasing Practice Revenue by Outsourcing Billing April 20, 2018

Outsource medical billingClinics busy with patients, doctors and staff can gain considerable benefits by thinking about how to streamline their workflow and make key elements of the practice more efficient. One area to consider is the revenue process and whether the needs of the practice are best met internally, or through the utilization of an external billing service. Practices need to ensure that they are getting the highest amount of revenue possible, and it is a worthwhile exercise to evaluate the billing system and processes. It’s a decision that requires some thought, weighing up the individual needs of the practice and considering the pros and cons of outsourcing before making the decision about which approach is most suitable.
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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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How to Turn Your Revenue Cycle Management Process Around September 25, 2017

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

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

Transform Your Practice Into a More Efficient One With Higher Revenue

Stethoscope on top of medical billing papersBilling is an extremely important part of operations for a medical private practice, and a quick and efficient billing process is a key driver of revenue. In order to ensure that your doctors are paid for their services, two main things must happen: First, the claims for services must be submitted in a timely manner. Second, the claims for services must contain the correct codes for procedures, treatments, and other services.
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5 Tips For Choosing a Podiatry Billing Service June 30, 2017

podiatry billing tips

For the most part, medical billing companies are designed to offer a generalized service to all types of medical practices. Not distinguishing between the various different medical fields, these companies offer a broad “one size fits all” kind of approach when it comes to the billing services they provide.

This approach, though beneficial to them, as they can service more clients in this way, does not necessarily fully support your podiatry practice.

As a specialist yourself, you will appreciate that your practice has specific billing demands that require the services of a billing company that can understand your needs. It makes sense therefore to choose a podiatry billing company as they will have a thorough understanding of your chosen medical field.

Podiatry Billing Service

In choosing a podiatry billing company to assist you, you will be teaming up with a company that understands exactly what kinds of services you are offering, know what prescriptions and medical products you are dispensing, and will be able to offer you the best billing strategy.

Podiatry billing companies work only with podiatrists and they already know what you are talking about, there is no need to explain what it is what you are billing for. In this way, they are able to focus their attention on getting your clients to settle their bills and offer greater customer service to your patients.

This will allow you the freedom to focus more on your practice and patients, knowing that you are outsourcing to people who understand and appreciate your medical practice as well as you do.

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What to Ask a Medical Billing Service Before Hiring Them May 31, 2017

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

1. How much does your service cost?

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

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

2. How will my account be handled?

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

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

3. What qualifications do your service and staff have?

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

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

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


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

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

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

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

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

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

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

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

The Process of Care is Shifting to Slow Spending

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

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

Data is King

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

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

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

Partner With The Right EMR

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

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


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