Practitioners of the medical arts are always seeking ways to reduce costs while continuing to provide the best level of patient care possible.
Three ways that practices can accomplish this is by contracting with the best payers, utilizing clearinghouses to process claims, and implementing an integrated electronic medical record (EMR) system. Nitin Chhoda examines the advantages and savings for clinicians in this informative new article.
Millions of reimbursement claims are transmitted digitally each day via EMR technology. They arrive at their destinations in real time and each is documented by one of several clearinghouses located throughout the nation.
Technological advances have done away with the need for postage stamps, paper claims and waiting weeks for approval or denials.
Secure Transmission
Electronic data interchange (EDI) allows practices to transmit reimbursement requests and supporting documentation to clearinghouses in a secure format that meets HIPAA requirements. It’s part of the abilities inherent in EMRs.
Billers can verify electronically that clients have met their responsibilities for any co-pays to help speed the claim along.
Destination Locations
Practitioners contract with insurance companies for payment and all submissions are sent to a specific clearinghouse where they’re scrubbed for any errors or mistakes. Clearinghouses handle a multitude of claims each day and clean claims are forwarded to the appropriate insurance company for payment. Clearinghouses and billers work together to meet the specific formatting requirements of each payer.
Clearinghouses deal with multiple medical providers and insurance companies at once, eliminating the need to bill each insurance company individually. Some charge flat fees or a fee per transaction for claims that are processed. The benefits far outweigh the costs, providing clinicians with a quick and reliable way to transmit claims, verify receipt of those claims, track their status and monitor payments.
Collecting Payments
Working with clearinghouses ensures that reimbursement claims are dealt with quickly for faster payment to physicians. Reimbursements can be electronically transferred to practice accounts in as little as 10 days.
Medical billing team and practitioners should keep in mind that even after a claim has been scrubbed at the clearinghouse it may still be rejected by the insurance company.
It’s the job of insurance carriers to find ways to deny claims. It’s how they make money. When a dispute arises, EDI allows practitioners to quickly discover why a claim was rejected and provide any additional documentation.
Billers can refer to the contract terms between the clinician and the payer and initiate communications to rectify any problems.
Clearinghouses work with multiple payers and millions of claims each week, speeding reimbursements on their way to their appropriate destination, saving practitioners time and money. They assist in verifying and sorting claims, allowing clinicians to collect reimbursements quicker than ever before and are an essential element in the payment process.
