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Medical Billing Clearinghouse

October 2, 2011 in Medical Billing/Coding

What is a Med­ical Billing Clearinghouse?

An elec­tronic med­ical billing clear­ing­house acts as a mid­dle­man that takes elec­tronic med­ical claims infor­ma­tion and then sub­mits it elec­tron­i­cally to insur­ance com­pa­nies the med­ical billing clear­ing­house con­tracts with.

Why Should a Med­ical Billing Busi­ness Con­sider Using a Clearinghouse?

Look at it this way: If you don’t use a med­ical billing clear­ing­house, your client sends you a med­ical claim in super­bill for­mat, you input that infor­ma­tion into your med­ical billing soft­ware, you print out that infor­ma­tion on to a CMS1500 form, you mail that form out to the appro­pri­ate insur­ance car­rier. The insur­ance com­pany checks the claim for any errors, if every­thing is cor­rect (called a “clean claim”) the insurer sub­mits pay­ment to the physi­cian for the ser­vices ren­dered and then you bill/invoice the physi­cian for the ser­vices that you pro­vided them. Now, how long do you think that process will take and what would be your expense? Well if you were to do this for each and every claim, for each and every client that you have, then I can assure you that it would only take about a month and a few weeks before you’d be out of business.

A med­ical billing clear­ing­house cuts down on the amount of time it takes for med­ical claims to be accepted and processed by insur­ance com­pa­nies. Today, the elec­tronic med­ical billing clear­ing­house also saves the envi­ron­ment because less paper is being used to com­plete the reim­burse­ment process.

Why Is An Elec­tronic Med­ical Billing Clear­ing­house A Must?

There are sev­eral rea­sons but these impact both your busi­ness and your profits:

  • Med­ical billing clear­ing­house soft­ware catches errors that you may have made dur­ing the data entry process.
  • Once a clear­ing­house catches those errors they let you know in real time where the mis­takes were made for each and every med­ical claim so you can cor­rect them, thus reduc­ing the chances of receiv­ing rejected claims.
  • You sub­mit your claims to a clear­ing­house elec­tron­i­cally so the clear­ing­house that you pick should also trans­mit your claims to the insur­ance car­ri­ers elec­tron­i­cally, which will dra­mat­i­cally reduce your reim­burse­ment time to less than ten days. I guar­an­tee you that your clients will love you to death and pay on time each and every month.
  • Using an elec­tronic med­ical billing clear­ing­house elim­i­nates the need for you to re-key data over and over for each payer, which saves you hun­dreds of hours in data entry. Plus, because they already have the insur­ance car­ri­ers’ infor­ma­tion in their sys­tem, you can worry less about human errors being made when trans­mit­ting claim information.
  • A med­ical billing clear­ing­house allows you to sub­mit all your claims at the same time, rather than sub­mit­ting them sep­a­rately for each indi­vid­ual insurer. Again, the faster and more cleanly your claims are sub­mit­ted to the car­ri­ers, the faster pay­ments are received by your med­ical billing client.
  • A med­ical billing clear­ing­house gives you a sec­ondary loca­tion from which to man­age all your elec­tronic claims — in addi­tion to the back ups that you cre­ate of your work on a daily basis, such as those on your com­puter, on CD/DVD, tape dri­ves, etc.
  • A med­ical billing clear­ing­house saves you from spend­ing valu­able hours of your time wait­ing on hold fol­low­ing up on claim errors or rejec­tions with sev­eral dif­fer­ent insur­ance carriers.
  • Elec­tronic med­ical billing clear­ing­houses dras­ti­cally reduce or elim­i­nate the need for you to print paper forms, envelopes and spend money on postage.

Sim­ply put, when you use a good med­ical billing clear­ing­house, your clients get paid faster so you can con­tinue to ser­vice your clients needs, which, in turn, will make your clients refer more busi­ness to you with­out your hav­ing to ask. As a result, your ROI (return on invest­ment) and prof­its will sky­rocket. In short, a med­ical billing clear­ing­house, espe­cially today’s elec­tronic med­ical billing clear­ing­house, can give your med­ical billing busi­ness a com­pet­i­tive advan­tage over your com­peti­tors who do not use them.

The Med­ical Billing Clear­ing­house You Choose Should:

  • Pro­vide you with a huge payer list from which you can choose.
  • Be nation­wide, NOT regional.
  • Pro­vide sync sup­port for the type of med­ical billing soft­ware you are using to cre­ate, batch and sub­mit claims.
  • Have an easy-to-get-out-of contract.
  • Pro­vide excel­lent cus­tomer ser­vice and support.
  • Give you online access to update, track and man­age the claims you have submitted.
  • Not charge exces­sive monthly fees that are beyond the indus­try norm.

The med­ical billing clear­ing­house you select should also pro­vide you with the abil­ity to process the fol­low­ing (Note: Some of these ser­vices can be offered to your clients at an addi­tional charge thus increas­ing your prof­its per client):

    • Eli­gi­bil­ity verification
    • Sent file status
    • Claim sta­tus reports

Rejec­tion analy­sis Drop and mail paper claims if needed Sec­ondary claims processing

  • Elec­tronic Remit­tance Advice (ERA)
  • Patient state­ment services
  • Pay­ment pro­cess­ing reporting
  • Trans­ac­tion sum­maries and reports of all your clear­ing­house activity

A home-based med­ical billing and cod­ing busi­ness is one that pro­vides physi­cians with sev­eral lev­els of ser­vices and a med­ical billing clear­ing­house does the same for the med­ical billing busi­ness owner. Be absolutely cer­tain that you shop around for med­ical billing clear­ing­houses that best fit your needs and bud­get — but DO NOT choose one strictly based on cost.

Elec­tronic med­ical billing clear­ing­houses must pro­vide at least the ser­vices I’ve men­tioned ear­lier. If you have to wait due to cus­tomer ser­vice issues at your clear­ing­house you will lose money, your per­sonal and busi­ness cred­i­bil­ity, and finally your valu­able clients.

Last, pay spe­cial atten­tion to the med­ical billing clearinghouse’s startup and enroll­ment fees that you may have to pay for each prac­ti­tioner or prac­tice you will be sub­mit­ting claims for. Those charges can eat into your prof­its. There are med­ical billing clear­ing­houses in the mar­ket­place that charge flat fees regard­less of how many physi­cians you bill for now or in the future, so proper research is the best way to keep your clear­ing­house expenses to a bare minimum.

Writ­ten BY: P.G. Hackett

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