Medical Billing and claim processing are very complicated for any healthcare facility. Different facilities utilize a variety of medical billing software to generate their claims. Then, they forward them to the insurance carriers for claim reimbursement.
We know that every state and even every insurance carrier within a state has its own rules and regulations. Traditionally, we used to employ USPS for forwarding the claims. So, the job calls for more manpower and attention to deal with all this.
Here, a Clearinghouse in healthcare acts as a middleman between medical providers and insurance payers nowadays.
In this article, we will see;
Let’s dwell on more details!
A Clearinghouse is a bridge between the provider and the payer. It forwards the electronic claims to the payer and checks out the medical billing errors for the providers in the submitted claims.
A healthcare facility deals with several types of medical claims. For example,
Clearinghouse in healthcare is the discipline for assuring the faster claim processing task. Whenever a clearinghouse receives a medical bill, it immediately starts claim scrubbing. After completing its process, it forwards a clear and complete reimbursement claim to payers. In other words, the clearinghouse in healthcare facilities provides financial security. For this they streamline the medical billing and coding process, enabling faster right information to be placed in the right place.
Along with the generation of electronic claims in a digital format, a clearing house does several other duties as well. It minimizes medical billing errors and follows a systematic procedure for doing so. A clearinghouse in healthcare plays its role by fulfilling all these tasks.
Check before the appointment if the insurance company covers the services the patient has asked for. Also, a medical clearinghouse verifies other details as well.
It’s an electronically modified form of EOB (Explanation of Benefits). This means, a clearinghouse uses this approach and auto-updates the payment and adjustments.
Once the billing house delivers the medical bills to their clearinghouse, it forwards them to respective insurance payers. Here, it manages all the payer edits and regulations as insurance company rules vary to some extent from state to state. Forwarding the claim is one of its duties only. The real job it does is to stay up-to-date with the current status of submitted claims.
A claim is usually rejected either by the clearinghouse or the payers due to errors. A clearinghouse in healthcare performs in-depth rejection analysis before resubmitting a rejected claim.
There is a myriad of reasons why a clearinghouse claim may be rejected. For illustration, the rejected claim possesses an out-of-state zip code. The patient’s or provider’s zip code must be accurate. It must always correspond to the state in which the patient resides or the provider practices. The clearinghouse can deny such a claim if the zip code is incorrect.
It’s good to trust a clearinghouse for its reliable claim-scrubbing process. But, medical billing experts in healthcare can also go with the direct claim submission option. Since some large insurance payers among US healthcare plan providers do their claim processing, thereby a medical provider can directly submit the claim without depending on a clearinghouse service.
This direct claim submission option provides two commendable benefits to providers.
Here, a query immediately pop-up in everyone’s mind, “If providers can submit claims by themselves then why choose a clearinghouse for this?”
Here is the detailed answer for clearing your mind!
Drawbacks of Submitting Claims without a Medical Clearinghouse
Direct claim submission on a payer’s portal demands manually re-keying data transactions again and again. Moreover, you have to follow the same process every time you visit a payer’s website for submitting a new claim. So, the probability of facing any human error automatically rises.
This depicts that medical billing experts already have a huge burden on their shoulders. Thus, reporting and submitting claims to different entities (insurance payers) will be an additional duty for them.
Overall, the Revenue Cycle may suffer from direct claim submission without a medical clearinghouse service. Therefore, it is not a good choice when your facility has to face;
Do you know?
The normal error ratio for paper claims is 28%. But thanks to the services of a clearinghouse in healthcare as it can reduce that to 2-3% only.
This simple analytical data reflects the significant role play of clearinghouses in healthcare. It not only assists in medical billing. Alongside, it is favored for the numerous benefits it offers.
A clearinghouse in healthcare provides advanced but desirable features for the claim processing. Its role in streamlining the medical billing activities of a facility is worth its weight in gold. Any facility must hire the best medical clearinghouse services provider to assist them in their financial matters with their experience and unmatched expertise.
