You'll probably also need to have your staff trained in the proper procedure. They'll need to learn how to submit the forms correctly to your clearinghouse, for example. If your staff is already using billing software and sending claims electronically directly to third-party payers, this shouldn't be too difficult for them.

Another issue is whether your chosen clearinghouse works with all of your third-party payers. Most clearinghouses work with a substantial number of payers, but they may not include everyone. This means your staff may still need to handle some claims without using the clearinghouse. If one of your major third-party payers does not work with your clearinghouse, then ask the clearinghouse to approach that payer about accepting claims through them on your behalf. Often, the third-party payers will agree.

After you first begin using a clearinghouse, you may find that a large number of your claims are initially rejected by the clearinghouse. Until your staff becomes comfortable with their claim requirements, you may not have a lot of “clean” claims, but most clearinghouses will assist your staff by providing detailed explanations of why they rejected a claim.

What Do Medical Billing Clearinghouses Charge?

The cost of working with a medical billing clearinghouse does vary, especially since these companies often charge in different ways. For example, some charge a monthly fee based on the number of medical providers work in your practice while others charge a fee for each claim you submit or a flat monthly rate.

One clearinghouse, for instance, charges $79 per month if your practice only has one service provider or $250 per month for practices with 6 to 10 providers. On the other hand, another clearinghouse charges 37 cents for each electronic claim.

There may also be additional charges. You will most likely have to pay more for claims which are not sent electronically. With one clearinghouse, the cost was an additional 14 cents per claim. Some clearinghouses have a list of participating payers for which they charge less. You can still submit claims through the clearinghouse for non-participating payers, but the fee per claim is higher.

Some clearinghouses also charge enrollment fees and may charge extra for some of their services. Before you sign up with a clearinghouse, make sure you understand all of these fees upfront, as well as which payers do participate in their service.

The Bottom Line

Medical billing clearinghouses can provide your practice with a number of benefits, including fewer rejected claims and faster reimbursement times, but you need to find the clearinghouse that will be the best match for your needs. Otherwise, the benefits might be outweighed by the cost.

Resources Used in Article

Hate Your Clearinghouse?
Solutions for Providers
Online Payment Transactions
Medical Billing Professionals
ProxyMed Clearinghouse 

About the Author

Amy Jorgensen is a freelance writer based in southern Indiana. Her articles have appeared in a variety of publications, including Southern California Physician magazine.

The author has no financial relationship to any of the companies listed in the article.

Topics #billing clearinghouse #EOB #medical billing #medical coding