Working with a medical billing solution provider that is HIPAA compliant is of utmost importance to you as a practice owner. The implications of not working in a HIPAA-compliant manner can impact your cash flow, and your practice, and can potentially shut down a practice if not done properly.
How Quest National Services Stays HIPAA Compliant
We want to make sure that all practices are staying compliant and are out of willful neglect and are doing regular and consistent security risk assessments to ensure their compliance. We, ourselves, utilize a solution provider that assists us through the process of maintaining our compliance.
How Do We Want Our Clients To Stay HIPAA Compliant?
We recommend our clients do the exact same thing to avoid hefty fines and potential litigation.
Working with a publicly traded company in 2022, we started by ensuring that each one of the diagnosis codes provided to us was applicable to each of the CPT codes that were going to get billed out.
Accurate Billing Reduces Claim Denials
Doing this eliminated any distractions and eliminated any reason for a denial to happen. With that, combined with our eligibility verification services, we ensured that each patient was actually eligible prior to submitting the claim and prior to that patient being seen, ensuring that each claim would get paid timely and properly for this publicly traded organization.
Testing Claims for Accuracy
Prior to us getting involved, 95% of this client’s claims were actually getting rejected for numerous different reasons. Prior to us even actually starting the process of routinely and regularly filing the claims for this particular group, we ensured that we submitted a test run of claims, ensuring that claims got paid timely and properly the first time.
Aiming for MGMA Standards
Over the past 15 years, we’ve ensured 90+% of all clients we’ve brought on have met these same expectations and standards. We’re going after those MGMA standards every day.
We’re in Business To Maximize Collections
Every dollar counts. That’s why we started the business and that’s why we’re still in this business today.
The biggest advantage we offer is that we are a one-stop shop for all of your healthcare needs. 15 years ago when I got started in this industry, I was out there to assist my clients with any needs that they may have had that made sense to our organization.
The Growth of Quest National Services
Today, we own seven companies, all centered around healthcare practices and healthcare organizations throughout the country and we serve our clients in a variety of different needs.
Advantages of a One-Stop Shop
That allows our clients to focus on what they do best, allowing us to focus on the back side of that office. From financial health care management to contracting credentialing, rate negotiation, and virtual assistance to help run the practice, both the front end and the back end, we are there to support our clients in every need. From HIPAA consulting and compliance to marketing, website management, and even EMR implementation, we’re there for our clients.
How We Compare to Our Competitors
Most of our other competitors are really good in one area, maybe billing, maybe consulting, maybe marketing, etc. We try to take everything under one umbrella and support our clients with each one of their needs. We’ve got a phenomenal billing team, many of whom have been with us for over 5 years. There are over 20 years of experience in our average biller and our average manager.
The Importance of Communication
Transparency, collaboration, and communication are of utmost importance to us. We’re going to communicate on a regular, consistent basis with you. That translates to each and every one of our other departments and other companies that I own throughout healthcare.
Communication With Our Clients
From marketing, we’re going to communicate extensively with you and ensure that you know exactly where we are every step of the way. Same with contracting credentialing. We want to make sure you know exactly where we are. It’s a tedious process that takes a lot of time.
Communication Sets Us Apart
We want to make sure that you know exactly where we are at every step of the process. That really does set us apart in the community.
A One-Stop Shop Means Faster Turnaround Times
The benefit of working with one umbrella company like ours is that we’re able to negotiate a little more aggressively when you utilize multiple service lines. In addition to that, the communication between those organizations that we own really helps translate into faster turnaround times across the board, whether it be credentialing, billing, marketing, etc.
Easy Collaboration Makes Turnaround Times Faster
Why? Because one organization is feeding the others information, we’re able to collaborate and therefore translate it into faster turnaround times for your organization.
By outsourcing medical billing to a professional service, you can streamline operations, reduce administrative burdens, optimize your practice’s financial health, and ensure compliance with industry standards, allowing you to focus on delivering quality patient care.
1. Reduces Administrative Burden
According to the Medical Group Management Association (MGMA), outsourcing medical billing services can reduce administrative tasks by up to 50%, allowing staff to focus more on patient care.
Managing in-house billing requires extensive time and effort from your staff, pulling them away from patient care and essential administrative duties. By outsourcing to a professional medical billing service, your team can focus on providing high-quality healthcare rather than chasing down payments or managing claim submissions. With experts handling billing tasks, your practice benefits from improved efficiency and a more patient-centric approach to operations.
2. Improves Cash Flow
According to the Healthcare Financial Management Association (HFMA), outsourcing medical billing can accelerate reimbursements by up to 30%, improving cash flow by reducing claim denials and payment delays.
A streamlined billing process ensures that claims are submitted accurately and on time, leading to faster reimbursements and a more consistent revenue stream. Professional medical billing services use efficient systems to track payments, follow up on outstanding claims, and reduce delays caused by errors. By improving cash flow, your practice can better manage operational expenses and reinvest in patient care.
3. Minimizes Errors
A study by the American Medical Association (AMA) found that outsourcing medical billing can reduce billing errors by up to 25%, leading to fewer claim rejections and faster reimbursements.
Billing and coding errors are among the leading causes of claim denials and delayed reimbursements. Professional medical billing services like Quest National Services employ trained specialists who understand complex coding systems and insurance requirements, reducing the likelihood of mistakes. Accurate claims submission not only accelerates payments but also minimizes the administrative burden of reworking denied claims.
4. Ensures Compliance
According to the Medical Group Management Association (MGMA), outsourcing medical billing ensures compliance with evolving regulations by engaging experts who stay current with the latest coding and billing standards, thereby reducing errors and enhancing financial performance.
Medical billing is subject to strict regulations, including HIPAA compliance and evolving insurance policies. A professional billing service stays updated on the latest industry standards and regulatory requirements, ensuring that your practice remains in full compliance. By outsourcing, you reduce the risk of penalties, audits, and legal complications associated with improper billing practices.
5. Access to Expertise
Outsourcing medical billing connects practices with experienced billing professionals, which, according to the American Academy of Professional Coders (AAPC), can improve coding accuracy and boost reimbursements by up to 20%.
Navigating the complexities of medical billing requires specialized knowledge that may be difficult to maintain in-house. Outsourcing to experts in the field provides your practice with access to experienced billing professionals who are well-versed in insurance policies, coding updates, and best practices. Their expertise helps improve accuracy, efficiency, and overall revenue management.
6. Accelerates Claim Processing
The Medical Group Management Association (MGMA) states that outsourcing medical billing can speed up claim processing by as much as 30%, reducing delays and ensuring faster payments.
Slow claim processing can lead to cash flow disruptions and financial strain. Professional medical billing services use advanced software and systematic processes to ensure that claims are submitted quickly and correctly. They also follow up on unpaid claims promptly, reducing turnaround time and keeping your revenue cycle moving smoothly.
7. Enhances Revenue Cycle Management
According to the Healthcare Financial Management Association (HFMA), effective revenue cycle management can increase collections by up to 15%, making outsourced medical billing a strategic solution for maximizing practice revenue.
A well-managed revenue cycle is essential for maintaining financial stability in your practice. Professional billing services optimize every stage of the billing process, from patient eligibility verification to payment posting. By streamlining operations, reducing errors, and improving collections, outsourced billing services help maximize revenue and minimize financial gaps.
8. Decreases Overhead Costs
The Medical Group Management Association (MGMA) reports that outsourcing medical billing can reduce overhead costs by up to 40%, minimizing expenses related to in-house billing staff, training, and technology.
Maintaining an in-house billing team comes with significant costs, including salaries, benefits, training, and software expenses. Outsourcing eliminates these overhead costs by shifting the responsibility to a dedicated billing provider. With professional medical billing services handling your revenue cycle, your practice can allocate resources more efficiently while reducing operational expenses.
9. Scalable Solutions
According to AAA Medical Billing, outsourcing medical billing offers scalable solutions that allow practices to handle increased billing volumes without disrupting operations, ensuring efficiency and consistent cash flow.
As your practice grows, so do your billing needs. Outsourced medical billing services offer scalable solutions that can adapt to fluctuations in patient volume, insurance changes, and regulatory updates. Whether your practice expands or experiences seasonal variations, a professional billing provider can adjust services to meet your evolving demands.
10. Provides Advanced Technology
According to the Medical Group Management Association (MGMA), outsourcing medical billing provides healthcare practices with access to advanced technology, enhancing efficiency and ensuring compliance with the latest regulations.
Professional medical billing services like Quest National Services utilize cutting-edge billing software and automation tools to enhance accuracy and efficiency. These technologies streamline claim submissions, track outstanding balances, and integrate with electronic health record (EHR) systems. By leveraging advanced technology, your practice benefits from faster, more precise billing processes.
11. Offers Detailed Reporting
According to the American Academy of Professional Coders (AAPC), outsourcing medical billing provides healthcare practices with detailed reporting and regular updates, enabling them to monitor financial performance and identify areas for improvement.
Data-driven decision-making is crucial for financial success. Outsourced billing services provide comprehensive reports that offer insights into claim statuses, revenue trends, and potential areas for improvement. With access to detailed financial analytics, practice managers can make informed decisions to optimize operations and enhance profitability.
12. Facilitates Seamless Transitions
Transitioning from in-house to outsourced medical billing can lead to revenue increases ranging from 11.6% to 20%, as reported by the Medical Group Management Association (MGMA) and Altrust Services, respectively.
Switching from in-house billing to an outsourced service can be a concern for many practices. However, professional billing services ensure a smooth transition by integrating with your existing systems, training staff on new processes, and maintaining cash flow stability during the changeover. This minimizes disruptions and allows for continued operational efficiency.
13. Continuous Support
Continuous support from a medical billing company can lead to a 15-25% improvement in overall revenue collection for healthcare practices, as reported by ZipDo.
Billing issues can arise at any time, requiring prompt resolution to prevent revenue loss. Professional billing services offer ongoing support to address claim rejections, patient billing inquiries, and insurance disputes. With a dedicated team available to assist, your practice can maintain efficiency and avoid delays in reimbursements.
14. Reduces Revenue Loss Risks
According to the American Academy of Professional Coders (AAPC), outsourcing medical billing can mitigate revenue loss by ensuring accurate coding and timely claim submissions, thereby reducing denials and enhancing cash flow.
Denied claims, coding errors, and missed follow-ups can lead to substantial revenue losses. Outsourcing to a professional medical billing service helps mitigate these risks by implementing best practices for claim submission, tracking outstanding payments, and ensuring compliance with industry standards. A proactive approach to billing protects your practice’s financial health.
15. Streamlines Workflow
According to the Journal of Medical Practice Management, outsourcing medical billing achieves an 80% first submission payment rate, surpassing the 68% rate of in-house billing, thereby streamlining workflow and enhancing efficiency.
Handling billing in-house often leads to workflow bottlenecks and administrative inefficiencies. By outsourcing, your practice can integrate billing processes seamlessly with scheduling, patient records, and insurance verification. This cohesive approach eliminates redundancies, reduces administrative strain, and improves overall operational flow.
16. Enhances Accuracy
According to the American Academy of Professional Coders (AAPC), outsourcing medical billing enhances accuracy by providing access to specialized expertise, leading to improved coding precision and compliance.
Precision in medical billing is critical for maximizing reimbursements and maintaining positive relationships with insurance providers. Professional billing services prioritize accuracy through detailed claim reviews, proper coding, and compliance checks. With fewer errors, your practice experiences fewer denials and a smoother revenue cycle.
17. Focus on Core Activities
Outsourcing medical billing can reduce administrative tasks by up to 50%, allowing staff to focus more on patient care, as reported by the Medical Group Management Association (MGMA).
Balancing patient care with administrative tasks can be challenging for medical practices. By outsourcing billing, your team can devote more time to patient engagement, treatment planning, and practice growth. A professional billing service takes the burden off your staff, allowing them to focus on what truly matters—providing excellent healthcare.
18. Improves Patient Satisfaction
According to the Medical Group Management Association (MGMA), outsourcing medical billing can enhance patient satisfaction by improving the financial experience through standardized revenue cycle management processes, leading to greater transparency and convenience for patients.
Billing transparency and efficiency contribute to a better patient experience. Faster claim processing, accurate statements, and flexible payment options help reduce patient frustration. With a professional billing service handling these aspects, your practice can foster positive patient relationships and improve overall satisfaction.
19. Flexible Contract Terms
Flexible contract terms with an outsourced medical billing company can reduce operational costs by up to 30-40%, as healthcare facilities often spend this portion of their revenue on in-house billing processes.
Every practice has unique billing needs, and professional billing services offer flexible contract options to accommodate those requirements. Whether you need full-service billing support or specific services, outsourcing providers can tailor solutions to fit your practice’s goals and financial strategy.
20. Access to Industry Insights
According to the Medical Group Management Association (MGMA), outsourcing medical billing provides healthcare practices with access to specialized expertise, ensuring accurate coding and compliance with the latest regulations, which can enhance financial performance and operational efficiency.
Staying ahead of industry trends and regulatory changes is crucial for maintaining a successful practice. Professional medical billing services like Quest National Services provide valuable insights based on data analysis, payer trends, and emerging technologies. Leveraging this knowledge allows your practice to optimize its revenue cycle and adapt to industry shifts effectively.
Avoiding Pitfalls When Switching Billing Services
Transitioning to a new medical billing service can offer significant benefits, but it also comes with challenges that, if not handled properly, can disrupt cash flow and negatively impact your practice. The key to a smooth transition is understanding potential pitfalls and implementing a structured plan to mitigate risks.
Risk of Revenue Loss During Transition
One of the biggest risks when switching from an in-house billing system or an existing billing service to an outsourced provider is temporary revenue disruption. If the transition is not carefully managed, delays in claims processing and payment collection can create cash flow shortages, making it difficult for practices to cover expenses such as rent, payroll, and equipment leases.
The Long-Term Impact of Poorly Managed Transitions
A poorly executed transition can have lasting financial consequences. If claims go unprocessed or payments are delayed, the financial strain can impact not only physicians but also practice owners and staff. A short-term cash flow issue can quickly escalate into a long-term problem, jeopardizing the financial stability of the practice. That’s why careful planning and coordination are essential when transitioning to a new billing provider.
Creating a Seamless Transition Plan
To prevent revenue loss, it’s crucial to implement a structured transition plan that clearly defines key milestones. This plan should outline:
The exact date when the new billing service will take over
A detailed timeline for data migration, training, and system setup
The expected deliverables from the new billing provider
How the existing billing team or service will continue operations until the go-live date
By ensuring that both the outgoing and incoming billing teams collaborate during the transition, your practice can maintain a steady cash flow throughout the process.
Common Transition Issues and How To Avoid Them
One of the most common mistakes in billing service transitions is a gap between the old and new billing systems. For example, if the previous billing provider stops working on June 30th and the new billing service starts on July 1st, but EDI (Electronic Data Interchange) enrollments haven’t been properly completed, claims processing can be delayed, causing significant cash flow problems.
To prevent this, your practice should ensure that all necessary integrations, such as Clearinghouse EDI enrollments and payer connections, are in place before the transition occurs. Testing and verifying that claims can be processed successfully before the go-live date will help avoid costly disruptions.
Ensuring a Smooth Billing Service Transition
A successful transition requires careful planning, testing, and communication. Before going live with a new billing service, make sure:
EDI enrollments and clearinghouse connections are properly configured.
The new billing software has been thoroughly tested.
Staff and providers are fully trained on the new system.
Standard Operating Procedures (SOPs) are documented and ready to implement.
The new billing service provider is prepared to handle claims immediately.
By taking these proactive steps, your practice can avoid revenue loss, minimize disruptions, and ensure a smooth transition to a professional billing service like Quest National Services. A well-planned switch not only preserves financial stability but also positions your practice for improved billing efficiency and long-term success.
Accurate claim filing not only helps to maximize your collections but also helps to protect you from the risk of audits. The more accurate the codes are, the more collections you can claim. Make sure that you know the latest oncology codes and their modifiers so you can
Oncology CPT Code Ranges for 2023
See the oncology center CPT updates for 2023:
77427 – radiation oncology physician management
81449 – targeted genomic sequence analysis
87468 – infectious agent detections
81418 – drug metabolism analysis using a genomic sequence
Oncology CPT Modifiers
CPT codes alongside any modifiers can improve the overall accuracy of medical billing. These are the updated oncology modifiers for 2023.
FQ – service with audio-only communication
FR – provider was present with audio-visual technology
For healthcare professionals to maximize medical billing collection, CPT code accuracy is especially important. If internal medicine CPT codes are not reported accurately in the billing process, the claim could be denied or the payment may be delayed. To maximize your collections, it’s therefore important to stay on top of the latest CPT code developments.
Internal Medicine CPT Codes for 2023
Stay informed on the internal medicine CPT code updates for 2023:
99201 – evaluation and management codes
99211 – office or outpatient visit for the evaluation and management of a new patient
99217 – observation care discharge services
99221 – initial hospital care
99231 – subsequent hospital care
Internal Medicine CPT Modifiers
Modifiers keep medical billing more accurate. Here are the updated internal medicine modifiers for 2023.
M1209 – at least two orders for high-risk medications from the same drug class
Keeping billing accurate is an essential element of medical collection maximization. If podiatry codes are not accurate, the claims may be denied. The more accurate a claim, the higher the potential collection amount. Therefore, it’s essential to make sure you know the latest CPT codes and their modifiers.
Podiatry CPT Codes for 2023
See the podiatry CPT code updates for 2023:
28001 – incision or drainage of bursa on the foot
28002 – incision or drainage below the fascia, with or without tendon sheath involvement
28003 – removal of sutures and staples not requiring anesthesia
76883 – ultrasound of the nerves in the foot
Podiatry CPT Modifiers
Modifier accuracy is also essential to maximize billing claims. Here are the updated podiatry modifiers for 2023.
Stay updated on the CPT codes and modifiers each year to maximize your medical collections. If your endocrinology codes are incorrect, claims may be delayed or denied in the process.
Endocrinology CPT Codes for 2023
Understand the endocrinology CPT code updates for 2023:
82000 – blood chemistry tests
82947 – blood glucose monitoring
83001 – thyroid function tests
83036 – hemoglobin A1C testing
84481 – parathyroid hormone testing
85013 – blood count (CBC) tests
85610 – coagulation tests
86300 – molecular diagnostic tests
96360 – hydration and injection therapy
Endocrinology CPT Modifiers
Having the coinciding modifier with a CPT can improve medical billing accuracy. The better the accuracy, the higher the possible collections.
25 – separately identifiable E/M procedure along with a non-E/M service performed by the same physician on the same day of the procedure or other service
Medical billing is an essential part of the healthcare industry, and it’s especially important that the billing is correct to maximize collections and reduce the risk of claim denials. If your urgent care practice’s codes are inaccurate, you could be missing out on collections or even get flagged for an audit.
Urgent Care CPT Code Ranges for 2023
Here are the updated CPT codes for urgent care in 2023:
S9083 – facility service fee
S9088 – billing for medical diagnosis and treatment
99202 – medical history exam
99214 – established patient’s review and management
99213 – enrolled patients who require treatment
medical history exam
99215 – face-to-face appointment
Urgent Care CPT Modifiers
Urgent care CPT codes and modifiers make claims accurate and help maximize collections.
25 – significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service
Accurate CPT codes are essential for
sleep center billing. If your claims are inaccurate, claims could be denied or you could trigger audits. To maximize your collections, make sure to stay up-to-date on the latest CPT code ranges and modifiers.
Sleep Center CPT Code Ranges for 2023
These are the updated CPT codes for sleep center services in 2023:
95810 – polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist
95782 – polysomnography attended by a technologist for a patient younger than six years old with 4 or more additional sleep parameters
95783 – polysomnography attended by a technologist for a patient younger than six years old with CPAP therapy or bi-level ventilation with 4 or more additional sleep parameters
95800 – unattended sleep study with recording, sleep time, and analysis of oxygen saturation, respiratory and heart rate
95801 – unattended sleep study with recording and analysis of oxygen saturation, respiratory and minimum heart rate
95803 – actigraphy testing with recording, analysis, interpretation, and a report
95805 – sleep latency and wakefulness testing
95806 – unattended sleep study with recording of heart rate, oxygen saturation, respiratory effort, and respiratory airflow
95807 – sleep study attended by a technologist with recording of ECG, heart rate, ventilation, or oxygen saturation
95808 – polysomnography attended by a technologist for a patient of any age with 1-3 sleep parameters
95810 – polysomnography attended by a technologist for a patient six years old or older with 4 or more additional sleep parameters
95811 – polysomnography attended by a technologist for a patient six years old or older with CPAP therapy or bi-level ventilation with 4 or more additional sleep parameters
94660 – CPAP initiation and management
99202 – new patient office visit level 2
99203 – new patient office visit level 3
99204 – new patient office visit level 4
99205 – new patient office visit level 5
99211 – established patient office visit level 1
99212 – established patient office visit level 2
99213 – established patient office visit level 3
99214 – established patient office visit level 4
99215 – established patient office visit level 5
E0485 – prefabricated oral device to reduce collapsibility of upper airway
E0486 – custom fabricated oral device to reduce collapsibility of upper airway
E0601 – CPAP device
E0470 – bi-level pressure respiratory device with backup rate feature
E0471 – bi-level pressure respiratory device without backup rate feature
G0398 – unattended home sleep test with type ii portable monitor
G0399 – unattended home sleep test with type iii portable monitor
G0499 – unattended home sleep test with type iv portable monitor
Sleep Center CPT Modifiers
To maximize collections, use updated CPT code modifiers to make your claims more specific.
