Medical Billing Clearinghouse Considerations

A Medical Billing Clearinghouse is essentially a middlemen that takes electronic medical claims information, checks the claims for errors, edits the information into a standard format and then sends that information electronically to the insurance companies with whom they are contracted.

It is very important that you choose a medical billing clearinghouse that is contracted with the majority of the insurance carriers that your Doctors use most often. This ensures that your claims will be handled electronically from start to finish.

Otherwise, if you send a claim to a clearinghouse which does not deal with a particular insurance company regularly, the clearinghouse will have to drop the claim to paper and mail it for you for an additional fee (which is typically higher than you could do it yourself).

You should be able to find a list of all insurance companies that the medical billing clearinghouse is connected with on the clearinghouse website.

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Medical Billing Clearinghouse Tips

Compatibility: Verify that your software is compatible with each medical billing clearing house you are considering. Since no single standard for medical billing software exists, not all software programs are compatible with those used by clearinghouses. One solution to this problem is to choose a web-based medical billing software which offers the convenience of fully integrated medical clearinghouse services. This way you do not have to spend your valuable time going back and forth between the clearinghouse and the software company every time there in is a significant change electronic claims filing procedures.

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Customer Service: You should expect free and unlimited customer service by phone and email. Will a live person answer the phone or do you regularly get directed to voice mail? If the latter, how quickly do they return return all phone calls and solve your technical support issues?

Claims Acknowledgement Report: The ability to check the status of all insurance claims submitted on line should be expected. The clearinghouse  scrubs the claims, checking it for errors, then gives you the opportunity to correct any billing mistakes and refile right away.

Eligibility Verification: This service confirms if a patient is eligible for medical insurance benefits. It also allows you to check the patient's co-pays, deductibles, maximum number of visits per year and if authorization or referral from a primary doctor is needed. It is ideal to check eligibility before the patient comes in for  their first visit.

Electronic Remittance Advice: An Electronic Remittance Advice (ERA) is basically an electronic version of the Explanation Of Benefits (EOB) that the insurance company sends with a copy of the check owed to the provider.

With more insurance companies utilizing Electronic Funds Transfers (EFT) it is also very helpful, if not mandatory, to receive the EOB's electronically as well.

Patient Statements: Printing, sorting, and mailing patient statements is a very labor intensive process. Some medical billing companies insist it ends up saving them money. We have talked to other billing companies who prefer to do it themselves so they are able to add personal notes to the patient statements.

Several owners have also pointed out that there is not much additional labor expense to doing the patient billing yourself as long as you have your staff stuff the claims while they are sitting on hold with the insurance companies.

Nationwide: Many clearinghouses are regional. Strongly consider ones that operate nationally. They will typically offer a larger list of insurance companies that they can file claims to electronically. Surprisingly, they are sometimes cheaper due to the larger volume of claims and services that they handle.

Cost: The cost of doing business with a medical billing clearinghouse varies considerably between clearinghouses and making a side by side comparison is difficult since very few companies structure their fees in a similar format. For example, some charge a flat fee per medical provider while others charge a fee for each claim filed. Some clearinghouses also have additional charges such as an initial setup charge, monthly fees, etc...

Before you sign up with a medical billing clearing house, make sure you understand all of potential "junk" fees before committing to a single clearinghouse. Be sure to compare all aspects, not just the price.

You've undoubtedly noticed that some clearinghouses advertise that you can file your electronic claims to them for free. One reason they are able to do this is because medical billing clearinghouses get paid by most commercial insurance carriers with whom they file the claims.

Also, these "free" clearing houses typically offer other services such as electronic remittance advice (ANSi 835), Electronic health records (EHR), patient statements, appointment scheduling, that they can profit from. Sometimes these fees are higher then the clearing houses that charge for electronic claim submissions.

The other thing to be wary of is that many of the free clearinghouses offer their own web based practice management system to providers and some even offer "billing services." If you own a medical billing company, now your clearinghouse just became a potential competitor of yours.

Every company has to make a profit to stay in business. If you're considering a "free" clearing house, make sure you understand how they make their profit. Do they offer "other" services for a higher fee or are they offering less customer service/support then their "paid" competitors?

The majority of clearinghouses will also drop any claims that cannot be submitted electronically to paper and mail them for you. Some offices prefer this method because they can just batch the claims and send them to the medical billing clearinghouse with their daily electronic submission. There is no printing, stuffing envelopes and mailing. In the past we have found clearinghouses that charge a per claim fee around 65 to 90 cents.

Many experienced medical billing companies prefer to print and mail the claims that do not go electronically themselves. While 65 or even 90 cents a claim may not sound like a good deal, remember that you will often have three or four claims going to the same insurance company, which will allow you to put all of them in one envelope with a single stamp, resulting in a per claim cost of closer to 15 or 20 cents.

You should be especially concerned if your PC based software vendor or web based software supplier only offers one clearinghouse option. If you become dissatisfied with the the service provided by the clearing house or the fees they are charging, then you will be forced to accept the unreasonable fee structure or change your billing software in order to have a better selection of medical billing clearinghouses.

While there are definite benefits to having a seamless clearinghouse integration with your software, it is still important to be able to switch to another clearing house if you were not getting the customer service you needed.

Although conducting a detailed analysis of all the fees and features offered may be time consuming, by performing due diligence you will be able to find the best medical billing clearinghouse for your needs, and it will be worth the time spent.

The Best Medical Billing Clearinghouse??

Which Medical Billing Clearinghouses are better-- Free Medical Billing Clearing Houses, or a paid Medical Billing Clearing House? What do YOU think?

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Paid vs. Free Medical Billing Clearinghouse 
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