Fresno, CA healthcare providers face complex billing challenges under California’s strict insurance regulations and Medi-Cal rules, where timely filing and accurate coding are critical for reimbursement. Our medical billing services in Fresno ensure compliance, reduce denials, and help practices maximize revenue while staying patient-focused.
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Nearly 90% of local clinics report higher profits within 3–6 months—partner with Stars Pro today and eliminate billing stress from your practice.
The California’s mental health reimbursement can drain your time private insurers like Kaiser and Aetna pay around 121% and 104% of the average, while Medi-Cal hovers near 73% and Blue Shield even lower at 70%. Meanwhile, therapists often receive just $80–$85 per session, barely covering overhead, with many avoiding insurance entirely due to these stagnant rates. Our Fresno-based billing team at Stars Pro verifies all insurances, ensures you’re properly credentialed, and negotiates realistic reimbursements, freeing you to focus on patient care, not paperwork.
For Medi-Cal mental health services, billing is especially complex, rates vary by service type (outpatient, mobile crisis, inpatient), and negotiated by county and provider. Recent policy shifts, like AB 119 and Proposition 35 have raised Medi-Cal reimbursement to at least 87.5% of Medicare rates for mental health services starting January 2024.
Our medical billing process for healthcare practices in Fresno, CA, is designed to maximize collections, reduce denials, and ensure compliance with California’s Medi-Cal and private insurance rules. With Stars Pro, your practice gains a streamlined system that saves time and improves cash flow.
Our team capture complete patient data, including Medi-Cal eligibility, private insurance details, and secondary coverage. By verifying policies upfront, we eliminate eligibility-related denials, which account for nearly 20% of claim rejections in California.
Our team secures prior authorizations and manages referrals before services are rendered. This is vital in Fresno, where Medi-Cal and insurers like Kaiser or Anthem require approvals for high-cost imaging, mental health, and specialty procedures to guarantee payment.
Accurate coding ensures compliance and maximizes reimbursement. We apply California-specific payer edits and specialty modifiers, reducing coding errors that often lead to down coding or underpayment—especially in cardiology, oncology, and mental health billing.
Services are carefully converted into billable charges with the correct fee schedule. Our team aligns charge entry with California’s Medicare and Medi-Cal reimbursement updates, ensuring providers don’t lose revenue due to outdated or mismatched charge structures.
We submit claims electronically through Medi-Cal’s DHCS system, NC Tracks for managed care, and private payer portals. Each claim is scrubbed for errors using payer-specific rules, cutting down Fresno providers’ denial rates by up to 30% compared to manual submission.
Insurer and patient payments are recorded in real time, with automated reconciliation against Fresno-area payer contracts. This helps practices identify underpayments quickly, especially from private carriers who sometimes reimburse below contracted rates.
We analyze denial codes, correct claims, and appeal promptly, ensuring nothing is left uncollected. In California, common denial reasons include missing authorizations and coding mismatches; our process cuts appeal turnaround time by 40% for local clinics.
Our billing experts aggressively follow up on unpaid claims, reducing A/R days and improving cash flow. In Fresno, where average reimbursement lag can stretch 45–60 days, our team helps practices bring that down to under 30 days with systematic follow-ups.
We deliver monthly reports with insights into denials, payer mix, and reimbursement trends. For Fresno providers, these analytics reveal where Medi-Cal vs. private payers impact profitability—helping you make informed financial decisions and forecast growth
In California, physical therapists face complex insurance laws—Medi-Cal reimburses around 80–85% of Medicare rates, while private payers like Blue Shield and Aetna often reimburse lower than national averages. State law requires claims to follow timely filing and medical necessity rules, and therapists must remain compliant with prior authorization requirements. At Stars Pro, we handle billing, A/R follow-up, and credentialing so California PTs can focus on patient outcomes instead of payer red tape.
Podiatrists in Fresno, CA, face strict compliance rules under both Medi-Cal and commercial insurers like Anthem Blue Cross and Blue Shield. Medi-Cal reimburses at about 80–85% of Medicare rates, with requirements for electronic submission and prior authorization for procedures like orthotics. Private payers apply timely filing rules (90–180 days) and enforce medical necessity documentation, errors here often lead to denials and delayed payments.
Commercial plans in California also follow the Knox-Keene Act, which regulates provider payments and claims timelines, while Medicare requires podiatry services to meet coverage criteria such as treatment of infections, ulcers, or foot care for diabetics.
Pediatric billing in California comes with unique challenges—state law mandates coverage for preventive care under the Knox-Keene Health Care Service Plan Act, while Medi-Cal’s EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) program requires strict documentation for full reimbursement. Major insurers like Anthem Blue Cross, Blue Shield, and Kaiser enforce prior authorization for vaccines, labs, and behavioral health visits, with timely filing windows ranging from 90 to 180 days. Our Fresno pediatric billing services at Stars Pro ensure compliance, accurate coding, faster reimbursements, and complete revenue cycle support tailored to this specialty.
Nearly 25% of cardiology claims in California face denials or payment delays due to coding errors, missing documentation, or insurance compliance gaps. In Fresno, where patient demand is rising, these mistakes can cost practices thousands in monthly revenue losses if not handled properly.
By outsourcing to our billing experts, cardiology providers can achieve up to a 98% clean claim rate, reducing A/R days significantly. With in-depth knowledge of California-specific payer rules and CMS updates, we safeguard your practice from costly errors and help you focus on patient care.
Oncology billing in Fresno demands precision, as complex chemotherapy codes and prior authorization rules often lead to claim denials exceeding 20% nationwide. Our specialized billing services ensure compliance, maximize reimbursements, and allow oncologists to dedicate more time to delivering quality patient care.
Nephrology billing in California is complex, with over 30% of claims delayed due to dialysis coding errors and frequent insurance audits. State laws, including California’s prompt payment regulations (Health & Safety Code §1371), demand strict compliance for faster reimbursements. Our Fresno-based nephrology billing services ensure accuracy, regulatory adherence, and maximized revenue so nephrologists can focus on patient outcomes.
Outsourcing medical billing in Fresno, CA helps providers cut administrative costs by up to 40%, while improving claim acceptance rates and ensuring compliance with California’s strict healthcare billing regulations. Our experts handle everything from coding to collections, so practices can focus on patient care and long-term growth.
Outsourcing helps providers reduce claim denial rates by up to 20%, ensures compliance with California’s Health & Safety Code §1371 (prompt payment law), and allows practices to focus on patient care instead of administrative tasks.
Key regulations include the California Balance Billing Prohibition (AB-72), which prevents surprise billing for out-of-network care, and timely filing requirements by insurers, typically 90–180 days. These laws make accurate billing essential to avoid penalties.
Cardiology uses high-value CPT codes like 93458 (cardiac catheterization), which require precise documentation. California insurers demand strict adherence to modifier rules and medical necessity for reimbursement, otherwise claims are delayed or denied.
Oncology billing faces frequent denials on chemotherapy codes (CPT 96413, 96415) due to prior authorization requirements. California law also requires coverage of essential cancer therapies, so billing experts must align claims with both state mandates and payer policies.
Nephrology practices deal with recurring dialysis codes like 90935 (hemodialysis, single evaluation). California’s Medicaid (Medi-Cal) program requires prior approvals for ESRD patients and pays differently than commercial insurers, demanding careful payer-specific billing.
CPT codes such as 97110 (therapeutic exercise) and 97530 (therapeutic activities) are subject to Medicare 8-minute rule and California-specific worker’s comp guidelines. Mistakes can lead to overbilling penalties under California Insurance Fraud Prevention Act.
Anesthesia codes like 00810 (lower intestinal endoscopic anesthesia) are reimbursed based on base units + time units. California requires accurate documentation of start-stop times, and errors can trigger payer audits or reduced reimbursements.
ENT specialists often bill for procedures like 31231 (nasal endoscopy) and allergy testing 95004 (percutaneous tests). California insurance carriers require clear linkage to ICD-10 diagnosis codes to avoid claim rejections, making coding expertise crucial.
Non-compliance with laws such as AB-72 (surprise billing) or timely filing rules can result in claim denials, financial penalties, or audits by California’s Department of Managed Health Care (DMHC). Outsourcing ensures consistent compliance.
Experts maintain 98% clean claim rates by using specialty-specific coding, ensuring compliance with California’s healthcare billing laws, and negotiating payer contracts. For example, in gastroenterology, CPT 45380 (colonoscopy with biopsy) requires precise modifier usage for maximum reimbursement.