If your practice submits electronic claims, you are most likely involved with a clearinghouse. Not sure what a clearinghouse is? According to clearinghouses.org,
"Clearinghouses are essentially electronic stations or hubs that allow healthcare practices to transmit electronic claims to insurance carriers in a secure way that protects PHI, or protected health information. Additionally, clearinghouses offer medical billers and billing managers a way to consolidate all their electronic claims and manage them from a single location, from an online dashboard control panel, similar to online checking."
Aside from basic electronic claims submission, a good clearinghouse should also provide:
- Insurance eligibility verification
- Claim status reports
- Electronic Remittance Advice (ERAs)
- Patient statements
- Claim scrubbing (checking claims for errors before forwarding to payers)
"The best clearinghouses today offer high value features that provide a whole new level of revenue cycle management intelligence that makes their services extremely compelling from a financial perspective and also highly desirable from an office-staff efficiency point of view. The average error rate for paper claims is 28%. But using the right clearinghouse can reduce that to 2-3%." — clearinghouses.org
Here are 6 advantages you get when you choose an EHR vendor with a built-in clearinghouse:
It’s direct. There is no third-party involvement. Built-in clearinghouses can connect directly to payer interfaces whenever possible, and if a payer works exclusively with a particular clearinghouse, a connection can be established behind-the-scenes so that there is no change to your workflow.
It’s cost effective. Built-in clearinghouses are already part of the product you are buying. Ideally your Practice Management system will include this service at no extra cost, although some vendors charge extra or don’t provide a clearinghouse at all, forcing you to hire a third-party service.
It simplifies the process for you. When a clearinghouse is built right into your software solution, you are shielded from having to waste your time and money trying to pick out a vendor who ultimately would not be directly integrated into your software.
It’s all-in-one. With a clearinghouse linked to a Practice Management system, reporting and claim data gets imported and presented in a consistent fashion. That level of integration doesn’t happen with third party clearinghouses.
It shows your vendor is invested in your success. Getting claims where they need to go is in everyone’s best interest, and of course any clearinghouse would feel this way. But when a clearinghouse is tightly integrated with a Practice Management system, a vendor has much more of a stake in ensuring clients are successful. From creating claims at the point of care all the way through automatically posting payments, a vendor who provides a built-in clearinghouse can be highly proactive when it comes to monitoring all of its connections and interfaces.
It enables your vendor to make decisions for your benefit. A vendor with a built-in clearinghouse can make choices on behalf of its clients. For example, if an interface a vendor works with does not live up to expectations, an immediate decision can be made to reroute to another one that is more cost effective and has better support. This happens behind-the-scenes so that clients’ claims submission workflow is not disrupted.
How about PCC? We offer a built-in clearinghouse for our clients at no additional cost. In 2016, we processed 3.9 million claims that got sent to over 700 payers. While we feature all the functionality of the large clearinghouses who work with clients using many different software vendors, our focus is solely on submitting electronic claims for our own clients. To that end, our clearinghouse is integrated directly with our Practice Management system. All of our clients use the same software, so processes such as checking claims for errors (claim scrubbing) can happen earlier in the workflow, at the point of care when they can be corrected quickly. Practices that use a third-party clearinghouse have a longer turnaround time for fixing errors, and therefore potentially have a longer wait time to receive payment.
Is your vendor helping you to get paid faster?