Medical Billing & Collection Services - Complete Outsource Solutions

Doctor Billing Services:

Initial Consultation & Initial Training

Our first step is to determine if we're a good fit for your needs. Not all billing services are suited for every practice. We aim to assist you effectively, so we'll begin by understanding why you're seeking our services and what your priorities are.

Once you decide to proceed, we collaborate with your staff to ensure timely and accurate information exchange. We aim to get things right from the start to secure the highest reimbursement in the shortest time. We have systems in place to facilitate efficient information exchange and will train your staff to work seamlessly as a team.

Controlling Critical Information

Accurate and timely information is vital for healthcare facilities and medical professionals to evaluate, plan, and deliver quality care. Medical Billing and Coding specialists play a crucial role in managing the flow of important data, serving as a critical link in the healthcare process.

Patient Entry

Many practices prefer our team to enter patient information directly into our software from intake documents. We double-check for accuracy and completeness before generating claims. Accurate patient information is essential for successful claims payment.

Billing

We audit the information for accuracy before entering it into our database and submitting claims electronically or on paper. We stay current with insurance regulations to ensure fees are at the maximum allowable reimbursement and focus on procedure codes to prevent suspensions or rejections.

We process secondary carrier claims upon receipt of the primary carrier EOB, ensuring maximum coverage by insurance companies and minimizing out-of-pocket expenses for your patients.

Daily Claims Submission and Follow-up

Most claims are sent electronically daily. We process claims for Medicare, BC/BS, Medicaid, and other payers, including Workers Comp, Personal Injury, and HMOs. Paper claims are mailed at least once a week, depending on practice size.

Posting Insurance Payments, Cash Payments & Adjustments

Each EOB is audited for correct payment and benefits. We analyze each EOB, enter appropriate credits, and take immediate action to process unpaid or reduced claims, ensuring you receive every penny you're entitled to.

Statements

We audit for accuracy before sending statements to patients. We create clear, concise, and informative statements to minimize patient inquiries - fully customizable to either summary or detailed format. We also create patient collection letters as needed.

Collections

We identify denials or difficult payers through reports and follow up with calls and appeals. Our collection features include:

• Instant access to accurate aging reports
• Collection calls and follow-up documentation
• Appealing delayed or denied claims with insurance carriers
• Monthly government credit reports for Medicare/Medicaid
• Refunds processing

Reports

Customized monthly reports are provided to suit the needs of the provider, including:

• Month-to-Date Summary of 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 for extracting any required information from the database

Checks

Checks are sent directly to you. Our goal is to help you get started or 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

A team of professionals works each month to bring in your money. We monitor the accounts receivable aging report, ensuring claims are paid promptly. If a claim is unpaid, we research the issue and notify your office for corrections and resubmission. Patient Statements are mailed as insurance payments and EOBs come in, in addition to your end-of-the-month statement run. An AR report is provided for clear progress tracking.

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 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 aging 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 are reduced as we scrub claims before submission and aggressively track, manage, and follow up on all denials.
• At your request, we can direct deposit funds into your account to ensure quick payment.
• We manage all patient billing, including printing and mailing statements and handling all patient inquiries.
• 5 Star can also provide consultative services, including credentialing, reviewing and negotiating insurance contracts, and optimizing superbills.
• We continuously track your net collection 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. We will also reduce your accounts receivable days outstanding, freeing up funds tied up by payers.

Regain Control of Your Business

5 Star unlocks insights within your 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 or detailed analysis on an individual claim? 5 Star offers this on any claim, at any time, and we'll help analyze your data to continually improve your business.

How Does 5 Star Billing Services Do It?

Integrated systems and processes are key. We focus on processes to prevent errors and maximize output. 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 and costs. 5 Star Billing Services stays abreast of the latest technologies to ensure you get the best solutions. We offer front-office software or interface with most major practice management systems. We also offer an integrated EMR system, if needed.

HIPAA

Healthcare data security is crucial and a legal requirement. 5 Star has implemented numerous security measures to ensure that your data is secure and in full compliance with all HIPAA guidelines on security and privacy.

Getting Started With 5 Star Billing Services

We ensure a smooth transition and implementation process. We can migrate data from your current billing system or service provider and train your staff on 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 can use our 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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