How to Select Perfect Clearinghouse for your Medical Practice?

How to Select Perfect Clearinghouse for your Medical Practice?

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.

We came up with five essential qualities to look for when researching clearinghouses to ensure that you’re making the best decision for your business.

1. Excellent Customer Support In order to select the best option for your facility and your patients, choose a medical claims clearinghouse that offers responsive customer service. For your facility, if your staff has to wait for hours on the phone to speak to a representative or wait days for a question to be answered, it costs you money.

Choose a clearinghouse that allows you to log an inquiry 24/7 and that will respond to you within 24 hours. 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.

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You can also review the clearinghouse's commitment to customer service hours and responses in its contract. In most contracts, these performance elements are known as Service Level Agreements (SLAs) and are contractual commitments, sometimes with penalties.

2. Quick Claim Status One of the benefits of using a medical claims clearinghouse is receiving quick updates once you submit claims. Once you upload claims, scrubbing them for errors and submitting them to payers takes minutes. You should know the same day if claims were accepted or if they need to be corrected and resubmitted.

The longer you have to wait for claim responses, the longer it takes before you can correct any errors. Select a clearinghouse that offers claim status for individual claims. Reduce delays to improve your relationship with clients and get paid faster.

3. Consistency and Accountability with 835s HIPAA requires health care insurance plans to use the 835 transactions set when paying providers and to provide an explanation of benefits (EOB). You should receive an 835 and payment within a consistent timeframe so that you can post and reconcile your payments quickly. Some medical claims clearinghouses take weeks or months after the transaction is complete to send 835s to healthcare facilities.

4. Efficient Claim Information It’s not enough to have all of the claim information in your system; you need to be able to use that information efficiently across multiple staff members, at the same time. For example, if you can view a summary of all claim statuses on an 835, your staff can immediately identify which payments to post and which claims to reprocess. Additionally, your staff should have the ability to update the claim statuses as they reprocess claims or post payments, so they don’t duplicate any work done on the 835. This enables you to track all claim activity from a summary report or dashboard without wasting time looking at each individual claim.

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5. Usability Choose a clearinghouse with easy-to-use features like humanly readable claim responses and 835s; detailed and customizable reports hosted in a secure, private cloud; and a minimal number of clicks required to complete your workflow. Not only do you need all the claim information accessible n your system, it’s often necessary for it to be accessible to multiple staff members at once. It’s key to be able to train your staff to use your system, especially as your staff changes or expands.

Find software that meets the needs of your practice and is easy to access by all the necessary staff members. Give your staff the capability to update claims as they post payment or resubmit corrections so you can view all activity without having to pull up individual claims.

6. Other Select a clearinghouse that lets you verify patient eligibility in real-time and offers extensive searching functionality for data access. Look for features like rejection analysis, secondary claims processing, patient statements and free summaries of your activity with the clearinghouse.

Working with a clearinghouse that has these qualities will help you to simplify your day-to-day processes, increase your cash flow and help your business thrive. We at Medical Biller and Coders (MBC) has experience of working with multiple clearinghouses. We can help you find the right clearinghouse as per your billing requirement. You can contact us at info@medicalbillersandcoders.com or visit our website www.medicalbillersandcoders.com to explore complete RCM services provided by us.

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