Medical Billing & Collection Services - Complete Outsource Solutions

Doctor Billing Services:

Initial Consultation & Initial Training

The first step is to see if we have a match; not all billing services are suited to take care of all customers. We would like to assist you in any way possible, so the first step is to determine why you are looking for our type of services and what is important to you.
Once you decide to move forward we work together with your staff to ensure that correct information is exchanged in a timely manner. We work with you and your staff as closely as possible to do things correctly the first time so we can obtain the highest reimbursement possible in the shortest period of time. We have set up systems to facilitate a very efficient exchange of information. We will train your staff on the systems so that everybody works together as a team.

Controlling critical information

Complete, accurate and timely information is absolutely vital in helping health care facilities and medical professionals evaluate, plan and deliver quality care. Directing the flow of important data is the responsibility of Medical Billing and Coding specialists who provide critical links in the health care process.

Patient Entry

Most Practices prefer a 5 Star team member to enter the patient information directly into our software from the patient intake documents. The patients are then double checked for accuracy and completeness before the claims are generated. Accurate and complete patient information is the first step to getting claims paid successfully.

Billing

Once we obtain information we enter it into our database and audit it for accuracy. We will then submit the claims electronically or print paper claims. We excel in accurately coding and billing for office visits, consultations, professional fees, technical components, professional and facility fees for hospitals. We keep current with insurance specifications and regulations and ensure the fees are kept at the maximum allowable reimbursement. We also focus on procedure codes so claims are not suspended or rejected.
We process Secondary Carrier claims upon receipt of the primary carrier EOB making sure that you receive the maximum amount covered by the Insurance Companies and minimizing out-of-pocket expenses to your patients.

Daily Claims Submission and Follow up

The majority of your claims will be sent electronically on a daily basis.
We process claims for Medicare, BC/BS, Medicaid and 1900 other payers. We also handle your Workers Comp, Personal Injury, Cash Payments, HMO and PPOs. Paper claims are mailed a minimum of once a week, sometimes daily depending on the size of the practice.

Posting Insurance Payments, Cash Payments & Adjustments

Each EOB will be audited for correct payment and/or benefits. Each EOB is carefully analyzed and appropriate credits are entered for the proper claim. If necessary, immediate steps are taken in order to process unpaid or reduced claims and make sure that you receive every penny that you are entitled to.

Statements

We audit for accuracy before we send statements to patients. We create clear, concise and informative patient statements to minimize the number of calls from patients needing clarification of their bills - fully customizable (summary or detailed format). We can also create patient collection letters.

Collections

We run reports to identify denials or difficult payers and follow-up with calls and appeals. Features:

• Instant access to accurate aging to know who is really delinquent
  
• Collection calls
  
• Follow-up and documentation
  
• Appeal insurance carriers on delayed or denied claims
  
• Medicare/Medicaid Credit balances - run report to catch monthly government credits
  
• Refunds
  

Reports

Reports are created monthly and customized to the needs of the provider.

• MTD Summary all Visits, New Patients, Charges, Total payments, Cash Payments, Insurance payments and Adjustments.
  
• Year to Date Report
  
• Practice Stats Report
  
• Payment report (by charges or payments)
  
• Procedure report on services with numbers and dollar amounts
  
• Patient referrals / Referring doctors
  
• Custom Report Generator: allows you to extract any information you need from the database
  

Checks

Checks are sent directly to you. Our goal is to help you get started or to help you improve your existing practice. Remember, if you don't get paid, we don't get paid. It is to our mutual benefit to collect the full reimbursement for services rendered.

Account Receivable Management

Each and every month a team of people will be working to bring in your money. We keep an eye on the accounts receivable aging report. Claims should be paid within a few weeks; if not, we run a patient insurance ledger as a tool to see why they are not paying. When a claim is not being paid on we research the problem and notify the provider’s office so the correction can be made and the claim can be resubmitted. Patient Statements are mailed as the insurance payments and EOB’s come in addition to your end of the month patient statement run. An AR report will be provided so that the practice can see the progress very clearly.

What you can expect

You Will Increase Your Cash Flow:

• Practice Analysis and Consulting Services As an Integral Component of Our Services
  
• Save on the High Cost of Equipment and Software
  
• Rapidly Changing Technology Translates Into Extra Expenses to Keep Updated
  
• Reduce Staff Size and Employees Expenses
  
• Eliminate Sick Pay, Vacation Pay, Insurance Benefits, Workers Compensation, etc.
  
• Eliminate Costly and Unproductive Training Periods
  
• Reduce Call Volume
  
• Your Staff Can Focus on Patient Care Instead of Phone Calls and Paperwork
  
• Reduction of Non-Productive Time. Your staff will be Free to do the Things that Make Money!
  
• No Cash-Flow Interruptions due to Staff Turnover
  
• Reduce costs: Postage, Supplies, Forms, Computers, Software, etc.
  
• Increase your office space by not having to have a “non-medical” business office
  
• Reduce Records Storage
  
• Get Detailed Reports
  
• The Hidden Cost of “Lost” Claims Because Someone Simply Didn’t Know The Next Step to Take
  
• Eliminate Provider/Patient Payment Discussion

The struggle between payers and providers over compensation continues to escalate as payers apply more and more resources toward reducing their reimbursements. Often it may seem as if these payers are really just in the claims denial business. Most providers simply do not have the resources, focus or expertise to fight this escalating battle.

The result is that providers usually have large sums tied up in ageing accounts receivable and unacceptably high write-offs; thus compensation far below what is expected – and deserved. Many providers are forced to deal with the minutiae of their business rather than the big picture, since they do not have the tools to manage their business, make informed decisions
or set strategy.

5 Star Billing Services exists to help you improve your financial performance and provide you with the tools and insights to achieve your business objectives. Successful businesses leverage systems and data to set strategy, improve processes, determine which customers to target, and increase revenues and profits. Healthcare providers should be no different and 5 Star Billing
services are geared to do just that – help you improve your business.

5 Star Complete Revenue Cycle Management

5 Star Billing Services offers a comprehensive revenue cycle management solution to improve your financial health and allow you to focus on clinical care and managing your business.

• We provide end-to-end management including patient input, coding, electronic claim submission, payment posting, denial management, and collections
  
• Delays are minimized and AR days reduced as we scrub claims before they’re submitted, and then aggressively track, manage, and follow up immediately on all denials
  
• At your election, we will direct deposit funds into your account to ensure you get paid as quickly as possible
  
• We manage all patient billing including printing and mailing all patient statements and follow-up statements, and we handle all patient questions and calls
  
• 5 Star can also provide consultative services including credentialing, reviewing and negotiating insurance contracts, and developing and optimizing superbills
  
• We continuously track your net collection rate (the actual payment vs. the contracted rate) to ensure you are getting your fair share

Better Financial Results

5 Star Billing Services will improve your net collection rate and your average collection per charge, which translates to more money in your pocket every day, year in, year out. We will also reduce your accounts receivable days outstanding, which means less of your money is tied up and being used by payers to generate investment returns for their stockholders.

Regain Control of Your Business

5 Star helps you unlock the insights and intelligence within your own data to help you run your business better. We offer complete reporting solutions, including customized and on-demand reporting. Want real-time access to your data? Itemization and drill-down capability on an individual claim or adjustment? 5 Star offers this on any claim, any time. Plus we’ll be right there with you, analyzing your data and helping draw the conclusions required to continually improve your business.

How Does 5 Star Billing Services Do It?

Integrated systems and processes are the key. We are passionate about processes, because we know that a well-managed process prevents errors and maximizes the output. Most labor-intensive tasks can be systematized, which results in greater performance and translates into more money for you more rapidly. Billing errors are caught and corrected before they become
problems. We catch incorrect codes, data-entry mistakes, and missing information to avoid costly delays, denials, and resubmissions.

Leave the Technology to Us

Avoid technology headaches, the risk of obsolescence, and the heavy costs of servers, storage, networks, upgrades, service and support. 5 Star Billing Services will manage all of this for you, as we stay abreast of the latest technologies to ensure you get the best solutions. We offer front-office software for scheduling, patient registration or we interface with most major practice management systems. If you are interested in a clinical solution, we also offer an EMR system that is completely integrated and seamless with our practice management and billing software.

HIPAA

Healthcare data security is not only critically important, it’s the law. 5 Star has implemented numerous security measures to ensure that your data is absolutely secure, and is in full compliance with all HIPAA guidelines on security and privacy.

Getting Started With 5 Star Billing Services

We work hard to ensure that the overall transition and implementation process is handled smoothly and efficiently. We will work with you to seamlessly migrate data from your current billing system or service provider. Moving forward, all you will need is web access to view reports from the convenience of your own office, if you choose. And we can train your staff on the processes in just a few days, if applicable.

5 Star Billing Services – The Solution

More money, fewer headaches; more strategy, less administration. Most importantly, you have more billable clinical time and are able to use our critical insights to take greater control of your business. Interested in learning more about how 5 Star can help your practice be more successful? Please contact us for more information.

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