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Medical Billing Articles

Tips for Choosing a Surgical Medical Billing Service November 22, 2016

Surgical Team Discussing Medical Billing

Outsourcing medical billing services for surgical practices can help maximize claims payments and keep your practice compliant. This is accomplished through aggressive collection practices, efficient and accurate execution of billing tasks, and current knowledge of documentation regulations.

In this post, we outline important tips to keep in mind when searching for the right medical billing company to handle your practice’s accounts receivable.

Do They Focus on Your Specialty?

Each surgical discipline requires distinct guidelines, policies, and regulations when it comes to billing. Look for a medical billing company that has existing surgical practices as clients and that also has experience in your specific subspecialty. Make sure the company has certified, professional, and experienced medical coders and billers that will keep your practice compliant with HIPAA and OIG, maximize payments, and drive up revenue.

Do They Work With Your Current EHR Software?

Surgical medical billing services should streamline your practice’s operations. A medical billing company dedicated to making your revenue cycle more efficient, and as a result, your practice’s operations more efficient, should be able to work with your current EMR software.

Working with a medical billing company that can manage your revenue cycle using your EHR is key to achieving long-term profitability and productivity. Additionally, contracting medical billing professionals that can work with your EHR ensures that your office staff does not need to be re-trained on a new software, meaning they can keep doing business as usual.

Do They Invest in Customer Service?

When choosing a surgical medical billing service, one of the most important things to consider is customer service. It’s important to know that you will be able to access support when needed and that your phone calls and emails will be answered promptly the same day. Ideally, the medical billing company you choose will assign at least one individual that will be dedicated to your account.

Important Questions to Ask Before Choosing a Surgical Medical Billing Service

When comparing surgical medical billing services, it’s very important to prepare a list of questions that will provide you the information you need to make the most informed decision.

Some questions you may want to ask when researching medical billing companies include:

  • How many clients are you currently working with within my specialty?
  • How much experience does your personnel have working with my specialty?
  • What systems do you have in place to protect personal health information?
  • How many people will be assigned to my account?
  • What fees do you charge?

Consider 5 Star Billing Services For Your Surgical Medical Billing Services

5 Star Billing Services can help your surgical practice maximize claims payments, drive up revenue, and dedicate more time to value-based care for your patients. To learn more about our medical billing services, contact us online or call us at 480-821-1371.


How Smarter Medical Collections Can Improve Your Practice’s Finances October 25, 2016

Medical Collections

According to the America’s Health Insurance Plans’ Census of Health Savings Account – High Deductible Health Plans, the number of individuals enrolled in a high deductible health plan reached 19.7 million in January of 2015. This number is a dramatic increase from the 17.4 million reported in 2014.

With payment responsibility heavily shifting toward the patient, physicians need to change their strategy for collecting payments.
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Steer Clear of these Medical Billing Mistakes for a Successful Healthcare Revenue Cycle September 29, 2016

Medical Billing Mistakes Can Cost You Money

Efficient revenue cycle management ensures that healthcare providers can focus on what matters most: giving quality care to their patients. However, providers often struggle to bill effectively. Below are the most common errors committed by practices and clinics that prevent them from billing properly and collecting on money that the practice is owed.

Collecting incorrect patient information

The collection of patient data is the foundation upon which claims can be submitted and paid. Errors such as a misspelled name or an incorrect date of birth will result in a denied claims payment. Administrative staff should make a habit of double-checking the accuracy of information collected during the initial interactions with the patient.

Failure to check the patient’s insurance coverage

In the first quarter of 2016, the American Hospital Association reports that 43 percent of hospitals in the U.S. have spent more than $10,000 on managing claim denials, while 26 percent have spent more than $25,000.

It is important to evaluate the patient’s insurance plan and eligibility each time they schedule an appointment. The following questions can serve as a guideline for administrative staff when evaluating eligibility:

    • Does the patient have valid insurance that is accepted by your practice?
    • Does the patient have additional insurance?
    • Is all patient registration information correct?
    • How many visits is the patient allowed?
  • What is the patient’s responsibility regarding the cost of the visit?

Not informing patients of their payment responsibility

Within the past decade, the amount of high-deductible insurance plans has increased exponentially. This means that patients are taking on a greater financial burden in the payment of medical bills. Additionally, the cost of collecting payments from patients is higher than that needed to collect from payers, as it requires more time and money. This need for more resources is placing an even greater financial strain on hospitals and practices that are already struggling to collect payments and bring in owed revenue.

In order to ensure that patients are fully aware of their financial responsibility, clearly inform them of the balance due, and collect at least a portion of this balance at the time of the visit.

Manually submitting claims

The implementation of the new ICD-10 billing code proved to be less traumatic than anticipated. However, the American Health Information Management Association (AHIMA) has identified several recurring mistakes in submitted claims, and it will take some time for administrative staff to become proficient in the new code as well as the new documentation practices. Billing errors due to manual reporting can result in a significant loss of income and productivity.

Billing in-house when your staff is overworked

When a practice’s workload is high, administrative processes become less efficient and billing mistakes can be easily made. Keeping up with annual medical code revisions and billing practices add extra expectations that may overwhelm your staff.

Outsourcing billing services increases claims payments, decreases labor costs as well as resources allocated towards in-house billing, and overall increases revenue for hospitals, practices, and clinics.

To learn more about how outsourced medical billing services can help you make more money, limit overhead expenses, and make your practice more efficient, contact us online or call us at 480-821-1371.


Increase Your Revenue with Professional Billing Services February 1, 2016

Medical billing is a crucial part of running any healthcare practice. Providers depend on accurate and efficient billing practices in order to receive reimbursements from payers in a timely manner.

With numerous PQRS and meaningful use requirements, running an efficient practice is becoming more difficult. Staff members and healthcare professionals are required to stay up to date with PQRS, meaningful use, and a new ICD-10 code. It can be easy to become overwhelmed and frustrated with billing tasks when your top priority is giving your patients the time and attention they need.

Reimbursements from payers aren’t always clear or timely, and it can become burdensome to keep up with the costs of running a practice. Roughly $125 billion dollars misses the hands of physicians due to billing errors each year. Outsourcing billing services can solve numerous administrative difficulties and can help your practice dramatically increase revenue.

Reduce billing errors to ensure claims payment

Insurance companies are sticklers when it comes to correctly reporting medical codes and adhering to billing regulations. A missed code or billing error will result in a rejected payment. If this happens, physicians then have to enter into a long process of interaction with the insurance company in order to fix the mistake and apply for the payment a second time.

Medical billing professionals are thoroughly trained and experienced in medical billing to ensure accurate reporting so that providers get paid the first time a claim is sent. Accurately submitting claims results in increased reimbursements for the practice and quicker receipt of these payments.

Comply with medical billing rules and regulations

Billing regulations change frequently and cause frustration for physicians who are busy keeping up-to-date with changes regarding PQRS and meaningful use regulations, as well as learning an entirely new ICD-10 code. In addition, continuing education and training courses can be costly and time-consuming.

Lack of medical necessity is a common billing error that occurs when sufficient information for a patient’s diagnosis is not given to the medical coder. This could then lead to submitting a bill with the wrong code, and a denied claim by the insurance company.  Medical billing professionals stay current on all medical billing regulations, medical procedures, and ICD codes, ensuring compliance and lower cost for the practice.

Save money to allocate office expenses elsewhere

Smaller healthcare practices tend to place billing responsibilities on administrative staff, giving them too much responsibility and spreading them too thin. Overwhelmed by office tasks and ensuring a comfortable patient experience may not allow office staff the time to ensure maximum return on claims. In addition, too much work and office responsibility do not allow them the time to resubmit denied claims or to fight for delayed payments.

For hospitals and large clinics requiring their own billing department, office space needed for a billing department and the costs of retaining employees also present a financial burden. Using a medical billing service also helps ease the stress of retaining employees needed to staff a billing department. By outsourcing billing, practices can cut costs on office expenses, costly software updates, and can allow administrative staff to focus on their primary responsibilities.

Make operations more efficient

Administrative tasks are becoming more convoluted with PQRS and meaningful use requirements. A lot of time is used to educate staff members on the regulations that change frequently. Outsourcing billing services help ease the administrative workload in the office, so staff members can focus on running an efficient practice. With less burden of responsibility in the office and more efficiency, the practice may even be able to accept new patients and take more appointments throughout the day, whereas before this may have seemed impossible.

Retain existing patients and entice new ones

Physicians may easily become distracted by billing compliance and reimbursement disputes from payers. Delayed or denied payments can cause frustration and can significantly decrease the quality of the practice and may even affect the retention of patients.

Spending less time on admin work means that healthcare professionals can then focus more on patient relationships and care. This type of environment will help any practice retain current patients and attract new patients. 

For more information on medical billing services, contact us online or call us at 480-821-1371.

This article originally appeared on the 1st Provider’s Choice blog.


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

Iowa flag

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

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

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

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

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

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

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


Tips for Preventing Claims Denials November 5, 2013

Claims denials are a source of revenue loss for many healthcare facilities, specifically for those in Ohio. Yet organizations are often unaware as to how to improve the claims submission process. This lack of knowledge can result in repeated denials and interruptions in cash flow. Plus, when claims are not appealed or resubmitted for review, it basically means that doctors are working for free. In order to ensure that payment is obtained for services rendered – and that extra time and money isn’t being spent processing denied claims, it is important for billing staff to be efficient the first time around.

Here are a couple of ways an Ohio billing service can help physicians prevent denials:

Regularly monitor submission reports to track the reason behind each denial.

Monitoring reports is one of the best ways to find problems and figure out ways to fix them – and a medical billing company can help physician practices do this. Submission reports can be reviewed monthly – or more or less often, depending on the frequency of denials at a particular practice – and billers should take into account the number of claims that are getting denied, as well as what the cause is behind each one. Some common reasons for denials include:

  • Untimely filing
  • Incorrect modifier
  • Incorrect coding
  • Missing or incorrect information

Implement policies to prevent claims from getting denied in the future.

After identifying the reason claims are getting denied, it is necessary to address those problems so that they do not continue to occur. An Ohio billing service will know the reasons claims often get denied and will work with standardized submission and resolution processes to ensure that maximum reimbursement is achieved.

At 5 Star Billing Service, we handle high claims volumes and excel in accurately coding, billing, and finding data entry errors to prevent denials. We submit claims daily to prevent untimely filing; and we ensure that our physician clients in Ohio are satisfied with our medical billing services and benefit from high-performing billing departments. Our employees have in-depth knowledge of billing and claims submission processes, and they pay attention to small details to make sure that claims are submitted error-free the first time around. This means less follow-up work for us and more on-time payments for our clients.

To learn more about medical billing services for physicians in Ohio, call 480-821-1371 or contact us online.


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

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

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

Implement practice management software.

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

Verify insurance.

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

Check for errors in patient information.

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

Are you interested in learning more about our medical billing services? Contact us today by calling 480-821-1371.


Three Questions to Ask Your Pain Management & Surgery Center Billing Service Provider October 11, 2013

surgery center billing services

Making the decision to outsource your pain management billing to a third-party can be difficult, especially when it comes to choosing the right company that can meet the needs of your practice. After all, the performance of the billing company and their overall ability to handle your revenue cycle processes will determine your practice’s financial health.

Before making a final decision about outsourcing, it is important that you ask each potential medical billing partner the following questions. Getting answers will help ensure that the agency you ultimately choose to work with has your practice’s best interests in mind.

1. Will we have access to our data?

Whether your pain management practice chooses to outsource a few medical billing processes or every aspect of billing and collections, it is important for the third-party agency to be transparent and to share critical information with you whenever you need it. Professional pain management billing services will provide access to their system for monitoring and keep records of communications with patients, for example, so that you can monitor quality assurance at all times. Check with your outsourcing partner to see what they provide.

2. Will you provide detailed monthly reports?

Outsourcing pain management billing can help your practice be more hands-off and devote more time to patients. However, you still want to know how your practice’s finances are. Make sure your billing company provides regular reports about your accounts receivables, including how much they’ve collected and how much is still owed. These reports will help you determine how effective the billing company’s efforts are and which areas need improvement.

3. What kinds of fees or service charges will we incur?

billing services for surgery centersFee structures can vary from one pain management billing service to another; however, most third-party agencies will either request:

  1. a percentage of the total amount that they collect
  2. a flat fee per claim

Agencies that choose to charge a flat rate may also offer other accounting and administrative services that can be of real benefit to your practice. The fee structure that provides the greatest financial benefit to your pain management organization will depend on the amount of money you expect to collect each month. Be sure to review the terms of your contract carefully and ask questions if you don’t understand how something works.

5 Star Billing Services, Inc. has provided professional medical billing, collection and administrative services for pain management practices for many years. Contact us today to start reducing denials, decreasing costs, and improving cash flow.


Here’s How Minnesota Healthcare Providers Can Be Prepared for ICD-10 February 19, 2013

Medical billing

October 1, 2014 is an important date in the healthcare industry, and it is approaching fast. Physicians eligible for participation in the EHR Incentive Programs will face Medicare payment adjustments if they haven’t demonstrated meaningful use of certified EMR technology by that date – and it is also the deadline for medical professionals to start using ICD-10 codes. Working with a Minnesota billing service is one way providers can tackle the transition without feeling overwhelmed.

Many billing companies help ease providers’ strains by helping to establish conversion plans, conducting testing prior to the October 1st deadline, and even offering continued ICD-10 support. To ensure that that your practice’s revenue cycle management processes are not affected once the new codes go into effect, be sure to talk to your billing service or clearinghouse. Find out whether their systems can accommodate ICD-10 codes, when their upgrades will be completed, and when you can start sending transactions for testing.

In order to accommodate ICD-10 diagnosis and procedure codes, healthcare organizations will also need to make adjustments of their own. This includes conducting assessments of all health IT systems that might be affected by ICD-10 and carrying out necessary upgrades to ensure that the new coding system will function properly. Coding and billing staff will also have to be trained on working with the new codes in order to avoid cash flow interruptions.

About ICD-10

The tenth revision of the International Classification of Diseases (ICD-10) includes:

  • ICD-10-CM: the diagnosis code set that replaces ICD-9-CM Vol. 1 and 2
  • ICD-10-PCS: the inpatient procedure code set that replaces ICD-9-CM Vol. 3

ICD-10 features 68,000 diagnosis codes and 87,000 procedure codes – a significant increase from ICD-9, which includes 14,000 and 4,000 codes, respectively. For many physicians, just looking at the numbers can be overwhelming. However, the good news is that many of the codes are only slightly different. For example, the only difference with approximately one-fourth of ICD-10 codes is that they specify the side of the body. Meanwhile, another fourth of codes differ in how they distinguish between:

  • Initial encounters (i.e. initial fracture)
  • Subsequent encounters (i.e. follow-up of fracture healing normally)
  • Sequelae (complications or conditions that arise as a direct result of an injury, disease or event; i.e. follow-up of fracture with malunion)

Is your healthcare organization looking for a Minnesota billing service that is ready to start working with ICD-10? Contact us online or call 480-821-1371 to speak with one of our expert representatives.


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

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

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

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

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

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

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

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

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


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