As an EHR, you understand better than anyone how medical practices benefit from the use automated technology to run their day-to-day operations. From organizing and securely storing patient medical history, lab results, and treatment plans to streamlining provider workflow, EHR’s provide a solution to many providers’ pain points. However, one pain point that many EHRs don’t solve is medical billing.
Medical billing has become the headache of many medical practices. Learning how to navigate ever-changing CPT codes, patient eligibility, managing claim rejections, etc. has put a strain on billing admin and practice owners. This is where a claims clearinghouse comes in. EHRs that partner with clearinghouses can alleviate the burdens of medical billing, along with their other software offerings, making it a more robust solution.
EHR’s can leverage their partnership with a claims clearinghouse by advertising the additional solutions that their EHR can now offer; providing a competitive advantage over other EHRs that don’t provide clearinghouse services. Below are some of the additional features EHRs can offer by partnering with a clearinghouse.
Ensure Claim Accuracy
An electronic claims clearinghouse’s primary duty is to “scrub” or check for errors in claims. Accuracy has long been a stumbling factor in claims processing, with a lot of mistakes resulting from incorrect data entry. A claims clearinghouse can detect errors made during the data entry process for a claim.
Additionally, the likelihood of errors occurring when transferring claim information is lower because clearinghouses already have the insurance providers’ data in their system. The use of a clearinghouse results in more accurate processing, fewer denied claims, and a stronger working relationship between organizations. It is especially true in the insurance sector, where reliable data leads to increased claim success rates and faster reimbursements.
Standardize Claims According to Insurer’s Requirements
EHR providers, particularly smaller ones, lack the skilled personnel and resources necessary to match this third-party scrubbing efficiency for every form of insurance. Clearinghouses have ties with numerous insurance payers and ensure their software is compatible and take the effort to get to know their systems. Medical clearinghouses can utilize this to assist EHR providers in understanding rejections and provide suggestions to help providers satisfy insurance company claim requirements.
Manage Rejection
Managing rejections includes utilizing preventative measures to avoid claim denials, while also determining the source of any rejections you do receive so you can prevent them in the future. With a clearinghouse, scrubbing software checks for accuracy before claims are submitted, and denial management tools are used to manage denials and make sure that each one has been resolved by determining the source of the rejection so that you avoid it in the future. With ever-changing rules from insurance providers, utilizing these tools to learn that type of information is incredibly helpful to medical practices.
Centralize Data
Medical clearinghouses can process single or many transactions and provide timely claim updates on client portals. Another advantage is that managing claim information requires just one gateway, instead of having separate accounts for each insurance company for direct billing.
Submitting the claims as a batch saves time and increases reimbursements. Providers can shorten payment cycles with faster and more reliable healthcare coverage determination and claim submission. As a result, the organization can make more accurate financial projections.
Enhance Automation Through Continuous Claims Monitoring
Enhancing EHR procedures through collaboration with a clearinghouse also enables more monitoring of any given document. Because the clearinghouse transforms these paper-based medical data into digital files, their program can quickly analyze information anytime, without requiring human input.
Near-instantaneous submission of kickbacks or error messages enable you to address any red flag immediately. It is simple and quick to modify the status or encoding of a specific record if that change is necessary. Everyone benefits from faster payments because of this ongoing monitoring, which enables healthcare managers and executives to predict revenue more accurately—a crucial component for any expanding entity.
Reduce Operational Time
A clearinghouse partner may hold the key to freeing up time-consuming data input activities. Clearinghouses analyzes the data and delivers it as a native EMR file type. As a result, EHR providers can concentrate on matters that are as crucial as electronic data interchange. The clearinghouse gives EMRs in any file format required, making them ready for usage in the future, regardless of your workflow.
Provide Timely Claim Reports
Receiving timely updates after submitting claims is one of the advantages of using a medical claims clearinghouse. It only takes a few minutes to check claims for inaccuracies after uploading them before sending them to payers. You learn on the same day if shares were accepted or if they needed to be amended and resubmitted. A clearinghouse provides claim status for specific claims, which cuts down on delays and helps you improve client relations and pay more promptly.
Additionally, clearinghouses offer connectivity to payers so that your billing software may automatically analyze and submit payments to patient accounts once it receives ERAs (Electronic Remittance Advice). This aids in optimizing workflow and increasing office productivity by allowing you to know which claims are paid and in what amount ahead of time.
Verify Eligibility
Qualifications and benefits verification is one of the simplest ways to keep claims free of errors. Clearinghouses confirm plan coverage and any potential patient debt to make sure insurance information is accurate (e.g., co-pays, co-insurance, and deductibles).
The time that employees can save in the verification process is another factor to consider – electronic verification takes significant less time than manual verification.
Integrate Software
Another advantage of a clearinghouse is integrating the payer’s and EHR provider’s software. Although each payer and provider will likely employ a different software, these programs may not always be compatible. The payer and provider can allow each software system to communicate via electronic data integration (EDI) when using a clearinghouse that interacts with each program independently.
Enhance Your Software Offerings with a Medical Clearinghouse Today!
Enhancing your EHR software offerings is one of the best ways to guarantee you keep a foot ahead of your competitors. Instead of going through the long, expensive process of adapting new software capabilities, you can partner with a software solution that already has the additional capabilities your customers are looking for. Apex EDI is an industry leading clearinghouse in developing new tools that improve claim location, status, and enhancements to the paperless office. When you put the power of Apex EDI claims delivery to work with your organization, you’ll have the most powerful set of practice tools available.
To find out how a partnership with Apex EDI can benefit your organization, schedule a partnership demo and/or learn more here.
