In the healthcare industry, the clearinghouse you work with has a huge impact on your business. The more efficiently your clearinghouse processes and returns your information, the faster you will get paid, and the more payments you will collect.
The healthcare industry continues to grow and transform which has pushed healthcare providers to constantly adapt to these new standards. This is something that healthcare providers must remember when picking a clearinghouse to assist in the processing of insurance claims.
When working as a physician, one of the biggest hurdles is getting paid by insurance companies. Each payer is different, and will need a different set of paperwork, often different codes and protocols.
Why do healthcare providers need a medical clearinghouse?
As a reminder, a medical clearinghouse fulfills an intermediary role between healthcare providers and the insurance companies who ultimately provide payment for submitted claims. These clearinghouse companies take care of a process called claims scrubbing, which means they review all submitted insurance claims for errors.
The goal of claim scrubbing is to eliminate costly processing mistakes that lead to rejected or denied claims.
With this important goal, all medical billing clearinghouses must constantly update their information in order to operate effectively and help optimize the revenue cycle healthcare practitioners who are using these services. New challenges are changing existing healthcare industry models such as the shift from fee-for-service to a fee-for-value, MACRA, the expansion of increasingly sophisticated software, off-shoring of services, etc
With clearinghouses fulfilling such an important role, it can be a daunting task to pick or evaluate these services. To help streamline this task, here are three general questions to consider:
- Immediate Customer Support and Service
Initially discovering whether a medical clearinghouse has good customer service is a challenge. Investigate online reports, reviews as well as find other medical practitioners who have used the clearinghouse’s services. A major problem with some medical clearinghouses is that they are difficult to get a hold of or slow to respond to customer service request. This is a bad sign since a clearinghouse should help solve problems, not create new ones.
Quality customer service and support is a must, otherwise insurance claims are hindered and timely filing limits become a concern. The level of customer support should provide meaningful value to a medical practice. If health professionals feel like their medical practices are working for the clearinghouse, instead of the clearinghouse working for them these practices should look for a new clearinghouse.
2. Interface, security and functionality:
Healthcare providers need to have a clear vision in regards to what they need for their medical practice.
- Do they want a clearinghouse that has streamlined user features, or do they desire one that has additional capabilities but has a steeper learning curve for new users?
- What level of integration is needed?
- Will the medical clearinghouse act as a standalone solution or is it one of many software interfaces?
Having an integrated system that includes practice management, EMR or a hospital information system is convenient for workflow. For security, some medical providers purposely divide up their clearinghouse, EMR, billing database, etc.
- Productivity and Future Goals
Medical clearinghouses should quickly increase the productivity of healthcare provider’s back office. Yet, the medical clearinghouse should have the capability to provide increased features as the needs of a healthcare professional change.
Can the existing clearinghouse easily connect to other vital software and systems?
If a clearinghouse’s web interface has to constantly be rebuilt in order to connect to other support software, this is a problem. Health professionals should set realistic one, three and five-year goals. So as a medical practice grows, so should the capability of the software.
Healthcare providers are unique, so they should adopt the clearinghouse that is the best fit for their needs. In the end, the clearinghouse should work for the healthcare professional instead of the other way around.
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