Getting paid in a timely manner may be one of the most difficult aspects of your job. As you already know, claim rejections from third-party payers can slow down reimbursement. Plus, your office staff has to work harder by revising rejected claims and trying to interpret the EOB and supplied by insurance companies.
For these reasons, more practices are turning to medical billing clearinghouses. These clearinghouses have been able to help expedite the processing of claims and payment to physicians around the country.
What Are Medical Billing Clearinghouses?
Medical billing clearinghouses are central collection points for claims. A practice sends all of their claims, usually electronically, to the clearinghouse, regardless of who the payer is going to be.
The clearinghouse then does several things. First, it reviews each claim to check for billing errors, such as coding problems or other issues which might hinder payment of the claim. If no problems exist and the claim is considered “clean,” then it is then broken down the different payers – primary insurance, co-pay, secondary insurance – and invoices are sent out.
If the claim is not “clean,” then the clearinghouse will reject it and your staff will need to make corrections before resubmitting it. Ideally, your clearinghouse will find ways to assist you and your staff in reducing the number of initially denied claims. They may do this by holding educational seminars, by giving your staff samples to follow, or by providing concrete explanations of where problems are occurring.
Medical clearinghouses can also provide additional services, such as assistance with the verification of a patient's insurance and information about required co-payments. All of this extra information also helps the practice move smoothly and improves the chances that you'll receive timely payment for your services.
How Can a Medical Clearinghouse Benefit Your Practice
The biggest benefits of using a medical billing clearinghouse is that it can help you reduce the number of claims rejected by third party payers and can speed up the time between submitting a claim and being reimbursed for your services.
In some practices claim rejections can happen frequently. Clearinghouses, on average, have rejection rates from insurance providers of around 6%. This low rejection rate is achieved in several ways. For example, some clearinghouses actually make it possible for you to verify a patient's insurance eligibility online so you don't have to make a phone call or rely on the validity of an insurance card.
Clearinghouses, as mentioned earlier, also review each claim to make sure it is error-free. Their staff must be knowledgeable about both the requirements of the different insurance companies and of your practice to be able to do this effectively. Most claims are reviewed within 24 hours. If changes are needed, you're likely to learn about them electronically the next business day, not four or five days later by mail which used to be the common practice with third party payers.
Submitting claims electronically and having them reviewed does cut down on how long it takes for you to be reimbursed.
Clearinghouses also provide a number of other benefits. For instance, some give you the ability to check the status of all of your claims online. Some give you the ability to get authorization for certain types of treatment or send through physician referrals for approval by third-party payers online. This means your staff doesn't have to be on the phone with the insurance provider for hours trying to finalize these arrangements.
Medical billing clearinghouses are also useful because they can help your practice stay compliant with HIPAA laws.
How Do You Use a Medical Clearinghouse in Your Practice?
If you make the decision to enlist the services of a medical billing clearinghouse, then you'll need to make sure your practice uses appropriate billing software. Unfortunately, there is no single standard for billing software so not all programs are compatible with the software used by clearinghouses. You'll need to check with your clearinghouse to make sure your software is compatible with theirs.