What is clearing house in medical billing

Clearinghouse Definition According to www. Clearinghouses are electronic stations or hubs that allow healthcare practices to transmit electronic claims to insurance carriers in a secure way that protects patient health information, or protected health information.

Clearing houses offer medical billers and billing managers a way to consolidate all their electronic claims and manage them from a single location, from an online dashboard control panel, similar to online checking. Another definition of Healthcare Clearinghouse is: Healthcare clearinghouse means a public or private entity, including a billing service, repricing company, community health management information system or community health information system, and value-added networks and switches, that does either of the following functions: Processes or facilitates the processing of health information received from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction.

Receives a standard transaction from another entity and processes or facilitates the processing of health information into nonstandard format or nonstandard data content for the receiving entity. Functions of a Clearinghouse 1. Pre-encounter Administration As discussed above, in the times of increasing patient responsibility, the Clearinghouse must provide both real-time and batch mode of insurance eligibility verification.

Patient - Provider Encounter The Clearinghouse assists in compliant coding of patient encounters which enables to acclerate reimbursement and also reduce potential audit risk. Post-encounter or Back Office Administration Claims Submission In an ideal situation, the Clearinghouse must be able to send all the claims to all the payers electronically.

However, that may not always be the case since there are always a number of small payers that may not be set up for electronic submission of claims. In such cases, the Clearinghouse or your staff may be able to print the claim on paper and mail it to the payer. Additionally, the Clearinghouse must be able to provide an initial response rather quickly enabling the medical billing staff to fix the claim and re-submit it without any loss of time.

Payer Remittance and Posting Clearinghouses also provide connectivity to payers so that ERAs Electronic Remittance Advice are received by your billing software which can interpret and post payments to patient accounts in an automated manner. This helps in streamlining the workflow and improving your office productivity by knowing in advance which claims have been paid and in what amount.

You can also process your secondary claims much faster and shorten the number of days your receivables are outstanding. ERAs are returned in a consistent and easy-to-understand format and you can quickly search, view or print each remittance as needed.

Online ERA management tools offered by the Clearinghouse also enable you to categorize and correct your denials and manage the appeals process. Denial Management Denial Management starts from denial prevention. Patient Billing The best situation is when you can charge the patient at the time of providing service as soon as patient responsibility has been determined. Reporting and Analysis Delivering actionable and relevant metrics in the form of dashboards and real time reports can enable a practice to uncover problems and take remedial actions.

The Clearinghouse Process Typically, this exchange goes like this: Each claim filed in a medical billing software is transformed into a file that is compliant with ANSI-X format The file is uploaded to your medical clearinghouse account The clearinghouse checks scrubs the file for errors before transmitting it to a payer The file is then sent to the specified payer Depending on the situation, the payer can either reject or accept the claim Your clearinghouse receives an update about any errors that are detected by the insurance company and adds them to your dashboard Each transmission is carried out over a secure connection as required by HIIPAA Health Insurance Portability and Accountability Act.

Benefits of a Clearinghouse In general, clearinghouses work a lot like typical financial institutions that process transactions made electronically and check for errors along the way. Some of these errors are due to erroneous data entry. Medical clearinghouse software catches errors that a user may have made during a data entry process. For instance, it can pick up on typos made while collecting patient information during the data entry process for a claim.

Secure data transfer: Clearinghouses act as electronic hubs that allow healthcare practices to transmit claims to insurance providers in ways that secure PHI Protected Health Information. Data theft costs industries millions. A resource that eliminates this possibility therefore is worth its weight in gold. Backup claims information: Manage all of your claims information in one source. Fast and clean claims submission: Submit all of your claims to different insurers at the same time.

Paperless claims management: Since a medical clearinghouse relies on software to process claims, it eliminates or reduces the need for healthcare providers to rely on paper records like claims forms. Accurate data: Your practice receives accurate data which can help you make precise revenue forecasts with shortened payment cycles. Saves time: With a medical clearinghouse, you spend more time treating patients and less time billing them. Clearinghouse Selection Best Practices Billing is at the core of your revenue cycle.

To find a clearinghouse that best suits your practice, consider the following: 1. Clearinghouse Budget When looking for potential vendors, see if their price packages suit your budget.

Usability of the Clearinghouse Interface Intuitive software cuts down training time and helps run billing processes smoothly. Ask yourself the following questions during the selection process: Does the interface have components that can help you go through basic operations easily?

As a result, it is in the interest of the insurance company to appoint a Clearing House or TPA as well. Each Clearing House is associated with a large network of hospitals and is responsible to manage all aspects of claims for these healthcare providers.

This includes coordinating with you with respect to patient care and treatment, passing on bills to the insurance provider, who pays the bills. There are two ways patients can make a health insurance claim: Cashless Treatment and Reimbursement Treatment. A huge amount of paperwork digital and physical alike is generated on each of these types of claims, processed every day by the Clearing Houses.

If patients are making Cashless claims, the Clearing House collects documents from your healthcare facility and passes them on to the insurance agency. When using a clearinghouse that integrates with each software separately, the payer and provider are able to allow each software system to communicate through electronic data integration EDI.

With a friendly user interface that integrates with dozens of existing practice management softwares, Apex EDI is the premier choice for medical claims processing. Our clearinghouse is dedicated to upholding exceptional practices with regards to customer service, as well as compliance with federal privacy practices such as HIPPA. For more information, be sure to reach out to us on our Contact Us page. Articles with this disclaimer may not represent the beliefs or core values of Apex EDI.

June 6, What They Do A medical claims clearinghouse acts as a middleman between the provider doctor, dentist, chiropractor, etc. Benefits of Clearinghouses The main benefit of the clearinghouse is efficiency. Share on Social! Share on facebook. Share on twitter. Share on linkedin.