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Why You Need a Medical Billing Clearinghouse for Your Practice

It’s no secret that documents now exist in electronic forms more than paper formats. If you run a medical practice, you undoubtedly have experience with processing medical claims for patients’ medical bills. Filing electronic paperwork reduces the time and effort required to correct and send the claims. With the right medical claims software, you can streamline the business side of your practice and focus on treating your patients.

What Is a Clearinghouse?

A clearinghouse acts as a polisher for your medical claims, also known as ANSI-X12 837 files. To create the files, you use billing software that picks patient details and sends the claim to your clearinghouse account.

A clearinghouse is an electronic data interchange (EDI) that checks your claims for errors to ensures that they are in the right condition for submission to the payer (an insurance provider). Using an EDI reduces the time spent on sharing electronic files because it does not require mail exchange. You can use a clearinghouse for any medical practice.

What Are the Benefits of a Clearinghouse?

Avoiding Confusion

Processing hundreds of medical claims in various treatment and payment stages can be confusing. Investing in software that helps you store treatment information, follow up on payments, and prevent confusion caused by relying on your memory is prudent.

Having accurate information is vital because when medical disputes between you and the payer occur, you can strengthen your case and argue for full payment. Insurance providers often reject claims based on simple mistakes such as wrong spellings for patient names, incorrect addresses, and mismatched policy numbers.

Good software helps you record all patient details, including discussions between you and the patient, phone calls, and the dates of contact. All these details can help you claim payments from an insurance company by providing accurate information.

Keeping Your Practice Current

The healthcare industry is undergoing technological changes, and keeping your practice up to date ensures that you remain relevant and reliable. Collecting, compiling, and processing medical claims electronically is a critical part of the business. It ensures that you store information accurately and also keep records of all communication and transactions for fast payments. Both patients and employees appreciate a practice with efficient billing systems. In the longterm, a clearinghouse improves your brand, improves your employee retention, and attracts new patients.

Saving Costs

While keeping up with current technological improvements is critical for the continuous development of your team, it’s impossible to know it all. Your staff needs software that helps them process paperwork quickly and allows them to practice the core business- treating patients.

Investing in a clearinghouse is an effective and cost-friendly way to balance the business side of your practice. You don’t have to train your employees to check for errors in their documents. Instead, you pay for one service that autocorrects errors and compiles claims within short periods.

You can also take advantage of customer support from your clearinghouse provider. Once the service is up and running, your staff can contact the customer support directly in case of queries, which eliminates the need for long training sessions. Your staff can also access information about the software online through helpdesk, instead of approaching you or customer support to save time and costs.

Lastly, since you’ll submit all files electronically, you can avoid spending on stamps, envelopes, and printing services for medical claims.

Optimizing Time

When you submit an erroneous medical claim to a payer, they reject it and send it back to you for review. Your staff scans the documents once again to correct errors for resubmission. However, if your claims are clean, the payer submits part of the payment, and you can push for the next payment. The entire process is time-consuming, and accuracy ensures that time is used efficiently.

A clearinghouse optimizes your time by checking your claims for human errors such as missing data and incorrect data. Your staff may make errors when typing patient names, insurance information, and billing codes. What’s more, once you key in information, you don’t need to re-type it- this reduces the chance of human error.

Once you process your claims, you can send them in bulk to the payer, instead of mailing each patient file separately. With fast submissions, you can reduce the time it takes for the insurance provider to process payments.

Data Backup

Accidents at the workplace and natural disasters are unlikely, yet potential risks for your business. What happens when a flood sweeps away all your patient information? How can you prove medical claims before the destructive floods?

Clearinghouses provide a secure and reliable backup for all your data. You can access all your medical claims after the accident and ensure that you continue to receive pending payments. Should you need to recover the information for legal disputes, you can count on a clearinghouse to deliver all records.

Quick Document Retrieval

Imagine sifting through different files and drawers to find medical bills for one patient. Now imagine repeating the process for 20 more patients in one day- exhausting, right? With a clearinghouse, you can retrieve all patient records from your account within seconds. If you have return patients, you can retrieve their records for editing to ensure you keep all accurate records of treatment provided.

Handling Medical Malpractice

At one point in your career, you may face a medical malpractice claim that could cost you hundreds of dollars, and in severe cases, your license. Being armed with accurate patient records is the best way to fight a medical malpractice claim.

The case could drag on for five years, which means that relying on memory is impossible. You’ll be required to respond to several questions during the hearing to prove your innocence. Accurate patient records, including medical bills, can save your reputation and practice.

A clearinghouse helps you access old patient records in their original form. You can also find different documents quickly, especially when undergoing investigation. With the right information, you’ll feel confident during the hearings and be ready to defend yourself and your staff.

Data Security

Patient information is personal data, and ensuring it’s protection is critical for your practice. Data breaches are expensive to fix, also result in costly lawsuits and compensation. If your practice is starting to pick up, violating HIPAA rules could mean permanent business loss.

Investing in a clearinghouse partly transfers your cybersecurity burden to the EDI provider. You don’t have to worry about the security of patient information when sending electronic medical claims. As long as you ensure the security on your end, you can relax.

Integration With Different Software

The chances of using the same billing software as different payers in your region are slim. Without integration, sharing electronic files becomes challenging, and often requires email submissions. A clearinghouse integrates with different billing software and helps you share medical claims efficiently, without additional software. With an efficient document sharing systems, you can enhance communication between your practice and the payers.

Standard Documents

A clearinghouse helps you and the payer share documents in similar formats to reduce errors and confusion; no need to worry about converting documents to read and edit them, or download extra software to share documents. You can save time and improve efficiency at your practice by standardizing all medical claims.

Keeping Your Business Financially Healthy

After spending years building your practice, the last thing you’d want is a collapsed business due to inefficient billing systems. Unfortunately, it’s easy to focus on your patients and forget your finances.  

Insurance companies rely on clearinghouses that check your claims for errors before choosing to pay or not to pay. Even the tiniest details can cause a rejection, which works to the benefit of the payer. Once the claim is rejected, there’s a possibility of losing an appeal, which means that the payer won’t pay you for services provided. What’s more, moving a claim back and forth, lengthens the process and increases the likelihood of non-payment or late payment.

A clearinghouse ensures that you correct all errors and submit accurate medical claims for quick and indisputable payments. This keeps your cash flow reliable and ensures that you have sufficient funds to run your practice.

Centralization of Data

Medical payers allow practices to submit claims directly on their websites. Unfortunately, direct filing means that you and your staff need to submit each document individually across different websites. There are several disadvantages to taking the direct route.

First, you take more time switching between websites and keying in information repeatedly. Second, you become confused as you attempt to remember different passwords every time you log in. Third, you increase your chances of error because you repeat information, and may become tired during the process. Lastly, you have a hard time tracking data across different locations.

A clearinghouse provides a central location for all patient information and medical claims. You and your staff can access the software when needed across different parts of the practice. When necessary, you can quickly pull out different patient records with ease, from one centralized location.

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Apex EDI, Inc.
556 E Technology Ave
Orem, Utah 84097
Support: (800) 840-9152
Sales: (801) 383-0388
Fax #: (801) 642-0333
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