Why & How To Choose A Clearinghouse For Your Business

A clearinghouse plays an important role in the medical industry and the medical billing clearinghouse you choose can have a major impact on your business. The overall efficiency of how a clearinghouse processes and returns your information will be a guiding factor in the consistency and robustness of your practice’s revenue stream. Many of the best medical billing clearinghouses work diligently to get you paid promptly, without unnecessary delays in your revenue stream.

Finding the best medical billing clearinghouse for your small practice starts with evaluating some key criteria. If you are choosing a new medical billing clearinghouse, or this is your first time making a foray into this sector, you should look for the following things.

What Does A Medical Billing Clearinghouse Do?

A medical billing clearinghouse is a third-party entity that coordinates the process between the medical practice or physician and the payer institution. They are essentially a middleman who double-checks claims to ensure that all the necessary information has been entered correctly. If there is an issue, they can alert the physician or the practice who can correct it and resubmit the claim in a timely manner.

Knowledgeable Customer Support Staff That Responds Promptly

Waiting multiple days for an issue to be resolved can result in a delay in payment, so choose a clearinghouse that allows you to log an inquiry 24/7 and that will respond to you within 24 hours. How can you tell for sure if a clearinghouse offers high-quality customer support? “Generally, if you receive immediate acknowledgment and responses to inquiries while you’re researching a clearinghouse, you likely will receive the same treatment as a customer,” says Kevin.

Rapid Claim Responses & Quick Claim Checks

By the time you submit claims to your clearinghouse, they should be able to notify you within minutes of specifically which claims went through and which claims might have an error or missing field that requires resubmission. Delays in the claim check process can snowball and cause major delays in a practice’s revenue stream.

Demonstrates Accountability & Consistency With 835 Documentation

All 835 documentation and payments should be received in a consistent time frame. This allows your medical practice to post and reconcile payments quickly. If the medical clearinghouse has a reputation for inconsistent 835s and payments are processed slowly or inconsistently once you start working with them, it should be seen as a red flag. Left unaddressed this level of inconsistency, and arguable lack of professionalism can cost your in-house administrative staff a lot of time tracking down the correct information. It’s especially prohibitive for solo practitioners who are handing their own medical coding and medical billing services.

Able To Provide Efficient Claim Information

It’s of vital importance to be able to share information efficiently across multiple staff members simultaneously. This calls for a medical billing clearinghouse that gives you the ability to view a summary of all claim statuses on any 835. This way your administrative staff can immediately identify which payments need to post as well as which claims need to be reprocessed.

At the same time, your practice’s in-house staff should have the ability to update claim statuses as they reprocess claims or post payments, so they don’t duplicate any work done on the 835. This type of system makes it easy for administrative staff and solo practitioners to effectively track all claim activity via an easy-to-read summary report or some type of “Dashboard” without wasting time searching for each individual claim. This will save you, and your administrative staff a lot of time, while also helping to streamline communications if any issues need to be corrected or resubmitted.

Intuitive Interface & Ease Of Use

Solo practitioners and administrative staff need to be trained and well-versed with the medical billing clearing house’s software system. Ideally, the training should be minimal and require very little updating or retraining. You want to prioritize a medical billing clearinghouse whose system is easy to navigate and uses an intuitive interface. This includes key features such as human-readable claim responses and 835 documents that are detailed as well as the ability to generate customized reports. These reports should then be printable and easy to read when translated to paper. Rather than a system that essentially takes an electronic screenshot, or generates printouts where the text reflows.

Then all this information can be hosted in a secure, private cloud or a similar database that is easy to access, yet secure enough to remain compliant with all HIPPA standards. If the medical billing clearinghouse you are working with has a difficult interface or is unable to provide you with information in a timely, efficient manner, you might see this as a red flag that it’s time to look elsewhere.

Accreditation With The EHNAC

This is one of those small things that makes a big difference. When looking for a new medical billing clearinghouse you want to only choose one that is accredited by the Electronic Healthcare Network Accreditation Commission (EHNAC). In fact, there are some states and payer institutions that require medical practices to only use an EHNAC-accredited clearinghouse.

Conclusion

While you are researching medical billing clearinghouses, make sure to seek out some of their existing clients to gather their feedback. Some of the best clearinghouses will even allow reviews to be posted about them on their website or in trade publications. You should see this level of willing transparency as a major bonus and a sign that the medical billing clearinghouse holds itself to the highest industry standards for professionalism.

It can be tempting to just go with any medical billing clearinghouse, especially if you are a solo practitioner or a small practice with limited administrative staff. Though, there’s no doubt that investing the time in finding the best medical billing clearinghouse for your practice’s needs will go a long way toward saving you time, and ultimately money. Not to mention ensuring that you have a consistent as well as a robust revenue stream to feed the growth of your practice.