How Will ICD-11 Impact My Medical Billing Department? May 15, 2024

medical billing

The healthcare industry is preparing to switch from ICD-10 to ICD-11, and medical billing departments must adapt quickly and efficiently. If your billing department is not well-equipped, it can result in severe consequences, such as coding errors and delayed reimbursements.

In this blog, we’ll delve into the practical implications of ICD-11 for billing professionals. We’re here to provide you with the knowledge and tools necessary to navigate the shift to ICD-11 with confidence and competence.

Understanding ICD-11

The transition from ICD-10 to ICD-11 marks a significant advancement in healthcare coding systems. Unlike previous updates, which primarily focused on refining existing codes and expanding the classification system, the shift to ICD-11 represents a fundamental reimagining of how we categorize and document diseases and medical conditions.

ICD-11 coding introduces many vital improvements over its predecessor, including:

  • Enhanced specificity
  • Better alignment with current medical practices
  • Improved usability
  • More streamlined structure
  • Expanded code options for diseases and conditions
  • Integration of electronic health records
  • Increased emphasis on data interoperability

Additionally, ICD-11 introduces new chapters, such as “Traditional Medicine Disorders” and “Extension Codes,” to capture additional information. The development process also features greater collaboration among international stakeholders, ensuring a more globally relevant medical billing and coding system.

Timeline for Implementation and Adoption

As for the timeline in the US healthcare system, the implementation and adoption of ICD-11 will follow a carefully planned trajectory. While there isn’t a fixed timeline due to the complexity of transitioning large-scale coding systems, adoption typically involves phases of testing, training, and integration.

Healthcare organizations and providers may undergo training programs to familiarize themselves with the new coding system, followed by pilot implementations to assess efficacy and identify potential challenges. Once these stages are completed satisfactorily, broader adoption across the healthcare landscape can occur. 

Impact on Medical Billing Processes

The transition from ICD-10 to ICD-11 will significantly impact medical billing processes, influencing various aspects of diagnosis coding and reimbursement procedures. These aspects include:

1. Changes in structure and classification. The structure and classification of diagnosis codes undergo refinement, with ICD-11 offering a more logical and intuitive organization. This allows for easier navigation and accurate code selection, potentially reducing coding errors and claim denials.

2. Expanded code set and specificity. This increased granularity enables healthcare providers to capture a broader range of conditions and manifestations, leading to more precise diagnoses. While this enhances clinical accuracy, ICD-11 codes also demand greater attention to detail in documentation and coding practices.

3. Effects on reimbursement and claims processing. The transition to ICD-11 requires adjustments in billing systems and payer policies. Providers must ensure alignment between diagnosis codes and reimbursement criteria to avoid payment delays or denials.

4. Increased documentation requirements. The adoption of ICD-11 also entails heightened documentation requirements to support the specificity of diagnosis coding. Healthcare professionals must capture detailed clinical information to reflect patient conditions, treatment plans, and outcomes accurately. While this change promotes more complete medical records, it may initially pose time and resource challenges.

Preparation and Transition Strategies

Successful implementation of ICD-11 adoption hinges on effective training, complete infrastructure, and collaborative efforts among clinicians, medical coders, billers, and staff.

Education and Training

Provide comprehensive training to familiarize medical billing/coding staff with the new ICD-11 system. Such learning sessions ensure they understand the ICD-11 code structure, classification changes, and increased specificity requirements.

Review of Coding Policies

Existing coding policies and procedures must be thoroughly reviewed and revised to align with ICD-11 requirements, ensuring consistency in the coding process.

Ensuring Compliance with Guidelines

Compliance with regulatory standards and guidelines for medical coding and billing should also be monitored and enforced throughout the transition to ICD-11. Besides consistency, this approach helps reduce the risk of penalties for non-compliance.

Engaging with the Medical Billing Partner

Close collaboration with your medical billing outsourcing partner must be maintained throughout the transition to ICD-11. This ensures the alignment of processes, systems, and expectations, which mitigates disruptions and optimizes billing operations’ efficiency.

Establishing Cross-Functional Teams

Consider forming cross-functional teams with representatives from IT, clinical, billing, and compliance departments to facilitate the smooth implementation of ICD-11 and foster collaboration through problem-solving.

Tracking Success in ICD-11 Adoption

Determining the success of ICD-11 adoption in a medical billing department involves assessing several key metrics and indicators. Here are some factors to consider:

  • Check for a decrease in coding errors and inaccuracies.
  • Track any increase in timely reimbursements and a reduction in claim denials.
  • Evaluate whether there are improvements in revenue capture, billing efficiency, and overall financial performance.
  • Assess whether there are improvements in workflow processes, resource utilization, and staff productivity.
  • Monitor adherence to coding standards, documentation requirements, and privacy regulations.
  • Measure billing staff proficiency in ICD-11 codes and assess their confidence in navigating the new coding system.

By closely monitoring these indicators, medical billing departments can evaluate the success of their ICD-11 adoption efforts and make informed decisions to optimize billing processes.


The transition to ICD-11 will represent a significant leap forward in healthcare and medical billing departments. This shift is anticipated to impact medical billing processes, necessitate adjustments in coding policies, and align reimbursement criteria. Transition strategies and expert medical billing services are vital to a billing department’s successful adoption of ICD-11.

Tap Into Our Expertise 

When the time comes, and you are facing the challenges of transitioning, choose 5 Star Billing Services for reliable coding and billing support.

Discover revenue cycle management solutions designed to improve your practice’s financial health while enabling you to focus on patient care:

  • ICD Coding Support: Our team of seasoned experts ensures a seamless transition to ICD-11, providing guidance every step of the way.
  • Medical Billing Solutions: From patient input to collections, we handle all aspects of medical billing, optimizing efficiency and accuracy.
  • Expert Consultation: Whether you need help developing an ICD transition plan or facilitating coding training, our consultants provide expert assistance.

With 5 Star Billing Services, you can trust that your billing processes are in capable hands, allowing you to navigate the complexities of ICD-11 adoption with confidence. 

Reach out to us today and experience the 5 Star difference.

How to Optimize Pain Management Coding and Billing 2021 September 9, 2021

Pain Management Code

Change is inevitable in healthcare. Providers are seeking ways to streamline medical billing and coding. Therefore, advanced technology is vital to achieving optimum efficiency in coding and billing processes. 

Pain Management Crisis

Chronic pain is a colossal public health issue. It costs billions of dollars in lost productivity and creates major health problems. According to the Centers for Disease Control (CDC), more than 50 million U.S adults suffer from chronic pain or one in five adults. As incidents of long-term arthritis and age-related conditions go up, this number will continue to rise. There will be more demand for pain medicine in the future. Additionally, payer demands are becoming a hassle. Prior authorization requirements put pain management at risk, affect fee schedules, and require patients to shoulder financial responsibility. 

How to Optimize Coding and Billing in Pain Management Practices

Utilizing the latest technology in revenue cycle management allows your practice to get paid for work in a timely and efficient manner. In pain management, coding and billing solutions are readily available to help your practice. We will explore the latest solutions that help optimize pain management medical billing and coding:


Medical practices know that medical billing is a vital but demanding task. Revenue cycle tasks such as patient scheduling, insurance verification, claims management, AR follow-ups, and payment collection can be challenging. When revenue is at stake, the quality of patient care goes down. That’s why many healthcare providers in pain management consider medical billing outsourcing. 

Outsourcing billing and coding allows practices to:

  • Achieve a flexible schedule for staff.
  • Maintain continuity and manage risks.
  • Boost growth.
  • Manage the basic tasks efficiently.
  • Ensure operational control.
  • Make sure reimbursements are prompt.
  • Reduce expenditures.
  • Increase productivity.
  • Cut revenue leaks.
  • Balance AR (account receivables)

Outsourcing is an effective way for medical practices to grow and expand while minimizing costs. Indeed, the best pain management billing company will help you ensure profitable revenue.

Automation of coding and billing

Automation is the future of medical billing and coding. Software automation can assist healthcare providers in cutting down unnecessary expenditures. Furthermore, it eliminates time-consuming tasks.. Billing automation can also bring considerable benefits to insurance pre-authorization. Moreover, the process of verifying eligibility and payment limits is simplified.. Thus, patients can get immediate care as soon as they need it.

Accurate pain management coding

Pain management coding always must be accurate. It’s the first step towards optimizing your healthcare revenue cycle management. A correct coding initiative is essential from a compliance standpoint. It is also helpful for reducing rejections, claim denials and ensures optimum reimbursements. Claims must be error-free and precise before they are sent out.

Here are coding initiatives that will increase collection and reduce denials:

  • Hire coding specialists for accuracy and efficiency. Partnering with a certified medical coder that focuses on pain management practices can quickly improve your cash flow.
  • Avoid non-specific diagnoses codes. In comparison with ICD 9, ICD 10 documentation requirements are much more detailed.
  • Avoid incorrect modifier usage.Make sure your coding follows payer-specific guidelines so that you don’t face denials or underpayments.
  • Avoid using a higher-paying code on a claim to receive big reimbursements. This refers to upcoding. This issue can cause more claim denials.
  • Stop upcoding and unbundling, as both are  illegal. Unbundling involves submitting bills piecemeal to maximize the reimbursement for tests and procedures that require billing together.
  • The process of Prior Authorization is necessary.
  • Stay away from under-coding – omitting or exchanging codes for a lower level of codes or less expensive code is leaving money on the table.
  • The medical necessity needs more documentation.

Switching to Telehealth 

The concept of a virtual visit is an interaction between patient and provider that doesn’t take place in the same room. It is also becoming more common in health care. For medical practitioners, virtual visits affect medical billing. The new CPT codes reflected the billing and procedures changes, so insurers had to update their policies right away. COVID-19 prompted many new treatments and protocols, which resulted in modifications to coding and billing. Health care providers lost a lot of money in the transition period due to denied claims. That’s why pain management billing software for your practice helps incorporate these changes. In addition, it prevents revenue leaks and ensures maximum future compatibility. 

New Software for Revenue Cycle Management (RCM)

What is Revenue Cycle Management software? It helps physicians and healthcare providers track and manage revenue from a patient’s lifecycle. Revenue cycle management solutions augment medical billing software functionality. It includes:

Seamless integration with EHR/EMR software – an easier way for exchanging data with the billing system.

Insurance eligibility and pre-authorization tools ensure the revenue collection process starts on the right path.

Advanced A/R management enables you to assist your facility’s staff and patients with the payment process.

Clearinghousean in-house intermediary service reduces  the time spent on the remittance process.

More important than ever, these features support financial operations throughout the life cycle of a medical facility.

Tap Into Our Expertise

It’s crucial to rely on current medical coding and billing solutions in light of these changes. These processes can further enhance your— billing processes, revenue cycle, and pain management practice.

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!

Pain Management: Signs You Need to Outsource Your Billing and Coding September 9, 2021

Medical billing and coding

Medical billing and coding are a great challenge for healthcare providers. Veteran surgeons and seasoned healthcare professionals see it as a struggle.  Regardless of the resources and assets, hindrances still occur.  It’s a parade of medical codes, insufficient time, and failure to follow-up for collections. How do you make more time for your patients? 

Medical practices are now finding ways to find the appropriate solution. In particular, pain management practices continue to deal with complex billing and coding. If your pain management practice seems to face many issues, you can always ask for our assistance. At 5 Star Billing Services, we offer comprehensive pain management billing services and collections. We can help your pain management practice grow.  So what are the signs that you need to outsource your billing and coding?

Late Payments

Following up on payments causes frustration. The increased reliance on patient payments requires an increased collection budget. Hiring a pain management billing service makes billing collections and claims easier. Our pain management billing experts track late payments quicker, so the in-house staff can focus on other tasks. About 54% of insured patients have trouble understanding their medical bills. We can also help patients clarify their confusion with their claims and other processes. 

The Decline of Patient Care

Spending more time on billing and coding than patient care is a big problem. Medical exams may get delayed when your nurses are busy with billing processes. In the end, your patients may end up walking out and never return to your practice.  Your staff is probably finding it hard juggling multiple tasks. That’s why outsourcing your billing and coding is the best option. Our pain management billing experts are always available to handle all the complex billing tasks on your behalf.

Pressure on staff

The administrative staff also faces difficulties with in-house medical billing. It’s time-consuming and frustrating. Training is necessary for up-to-date changes in rules and codes. However, it also takes significant time away from dealing with other admin tasks. In that case, you may need to assign tasks to other departments. Many practices are still hesitant to outsource their billing and coding. They fear that the cost will be prohibitive, but you can save a lot of money by outsourcing medical billing. It will help your practice become more efficient and help your staff maintain a work-life balance.

Loss of Workforce

High staff turnover is always a problem. When a staff member leaves, the remaining work might get divided among your team members. Often, these members lack medical billing and coding expertise, and new hires may leave before they complete their training. These issues reduce revenues, increase billing and coding errors, and erodes the quality of care. That’s why healthcare providers want the best for their pain management practices. Your patients can benefit from the services, and your pain management practice will be stable. In contrast, if staff resignations are piling up, it may be time to look for pain management billing services. Let the experts handle the tough job.

Struggle to find Staff Replacement

Finding qualified staff for your pain management practice can be hard. Both urban and rural areas are experiencing a shortage of skilled workers. Coding experts, medical billers, and administrative staff are especially hard to find. Other physician offices have high turnover rates due to problems with managers or office politics. According to the Medical Group Management Association (MGMA), practice costs have risen by 50%. 

Increase in Insurance Denials

To maintain compliance with insurance coverage requirements, AR and billing staff must continually handle insurance denials. A high rate of insurance denials could indicate a poor denial resolution process. Experts can help you expedite your transactions. Our AR management and electronic claims in pain management reduce delays. Also, we provide an initial evaluation of your practice before we move forward. 

Account Receivables are Too High

In a short time, account receivables (AR) can mount up. That might be because of faulty software or an inexperienced biller. You may need to restructure your entire patient-to-pay revenue cycle. Likewise, you may not have enough staff to handle claims errors and denials right away. AR levels can rapidly rise due to any of these reasons or a combination of them. The American Medical Association (AMA) stated that the average is now 24%, with half of that percentage collected at the point-of-service—thereby adding to the overall A/R increase. Further, an unclear collections success rate results in administrative waste, unnecessary write-offs, and a loss of bottom-line profit.

Tap Into Our Expertise

Pain management coding and billing are indeed strenuous. That is why we provide you with several reasons to consider medical outsourcing. With the help of an outsourcing billing company, your pain management practice will grow.

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!

Medical Billing Errors That Are Hurting Your Practice January 26, 2021

medical billing errors

Effective medical billing is the backbone of a successful practice. Thus, maintaining a healthy cash flow is every provider’s daily challenge. Any mistake, error, or delay will not only disrupt your flow but will also negatively affect your patient experience and patient retention. Therefore, it is essential to determine blockages that are hurting your finances. It will make it easier for you to streamline your processes, minimize errors, and improve the overall patient experience. We’ve gathered the top five medical billing errors and how to solve them: 

1. Limited Payment Options

Delay in your payment collection clogs up your cashflow. Consumers, including patients, prefer to settle their bills online through bank transfers, Amazon pay, PayPal, or credit cards. If you don’t offer at least some of these, that’s a problem.  Patients will pay more promptly if you give them a variety of payment options. 

Equip your patient portal with online payment options that comply with HIPAA and HITRUST standards. It will make it easier for your patients to pay you, increasing your patient collection in the process.

2. Incorrect Patient Data

Patient details are the foundation of your medical billing process. One typo on a patient ID number or name can get your claims rejected immediately. Always remind your staff to not just double-check, but to triple the effort using claim scrubbing software that can automatically detect typos, errors, or missing information.  

3.    Inaccurate Coding

Always get the updated version of your coding books. Coding guidelines, procedural, and diagnosis codes are updated annually. Coding errors are inevitable no matter how seasoned or experienced your staff may be. Make it a habit to conduct training or refresher courses for your staff for ICD-10 coding updates. 

4. Manually Managing Your Claims

There are still providers who are using a manual process for their denials management. If you are one of them, then it’s time for you to embrace medical billing innovations. You can get more 

insights through better analytics and improve your medical practice using automated EHR/EMR solutions integrated into your medical billing software. Some software has a checklist and alerts to ensure proper coding and billing practices. 

5.  Sending Claims to the Wrong Insurer

Sending the claim to the incorrect insurance provider is one of the simplest medical billing errors you can avoid. Usually, it happens because you do not have a copy of the patient’s insurance card. In order for you to send it to the right insurance company, always secure a copy of the front and back of the insurance card. Always ask the patients if there are any changes to their insurance, too. 

By eliminating the top billing mistakes in your medical practice, you can shorten billing cycles, maintain healthy cash flow, prevent regulatory violations, and deliver a better patient experience that will help you retain more patients and become more profitable.

Tap Into Our Expertise

By being aware of your medical billing errors, you can easily remove your blockages and improve your cashflow. 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

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!

  • © 2024 5 Star Billing Services, Inc.