Medical Billing Information Center

What is a medical billing clearinghouse?

An electronic medical billing clearinghouse acts as an intermediary that takes electronic medical claims information and then sends it electronically to the insurance companies that the medical billing clearinghouse contracts with.

Why should a medical billing business consider using a clearinghouse?

Look at it this way: if you don’t use a medical billing clearinghouse, your client submits a medical claim to you in a superbill format, enters that information into their Medical Billing Services software, prints that information on a CMS1500 form, submits that form to the corresponding insurance company. The insurance company verifies the claim for any errors, if everything is correct (called a “clean claim”) the insurer sends the payment to the doctor for the services rendered and then bills / invoices the doctor for the services he provided.

Now, how long do you think that process will take and what would your expense be? Well, if you were to do this for every claim, for every single customer that you have, then I can assure you that it will only take about a month and a few weeks before you go out of business.

A medical billing information center reduces the amount of time it takes for medical claims to be accepted and processed by insurance companies. Today, the electronic medical billing clearinghouse also saves the environment because less paper is used to complete the reimbursement process.

Why is an electronic medical billing information center a necessity?

There are several reasons, but they affect both your business and your profits:

  • The medical clearinghouse software detects any mistakes you may have made during the data entry process.
  • Once a clearinghouse detects these errors, they inform you in real time where the errors were made on each medical claim so that you can correct them, thus reducing the chances of receiving denied claims.
  • You submit your claims to a clearinghouse electronically, so the clearinghouse you choose must also transmit your claims to insurance companies electronically, dramatically reducing your reimbursement time to less than ten days. I guarantee that your clients will love you to death and pay on time every month.
  • Using an electronic medical billing information center eliminates the need to re-enter data over and over again for each payer, saving you hundreds of hours of data entry. Plus, since they already have insurance company information in their system, you can worry less about human errors when transmitting claims information.
  • A medical billing clearinghouse allows you to submit all of your claims at the same time, rather than submitting them separately for each individual insurer. Again, the faster and cleaner your claims are submitted to operators, the faster your medical billing customer will receive payments.
  • A medical billing information center gives you a secondary location from which to manage all your electronic claims, as well as the backup copies you create daily of your work, such as those from your computer, on CD / DVD, tape drives, etc.
  • A medical billing information center saves you from spending valuable hours of waiting time, tracking down claims errors or denials with several different insurance companies.
  • Electronic medical billing information centers dramatically reduce or eliminate the need to print paper forms, envelopes, and spend money on postage.

Simply put, when you use a good medical billing clearinghouse, your clients are paid faster so that you can continue to serve your clients’ needs, which, in turn, will cause your clients to refer you more business without having to ask. As a result, your return on investment (return on investment) and profits will skyrocket. In short, a medical billing clearinghouse, especially today’s electronic medical billing clearinghouse, can give your medical billing business a competitive advantage over competitors that don’t use them.

The Medical Billing Information Center you choose must:

  • Provide you with a huge list of payers to choose from.
  • Be national, NOT regional.
  • Provide synchronization support for the type of medical billing software you are using to create, group, and submit claims.
  • Have an easy-to-obtain contract.
  • Provide excellent customer service and support.
  • It gives you online access to update, track and manage the claims you have submitted.
  • Do not charge excessive monthly fees that are beyond the industry norm.

The medical billing clearinghouse you select will also provide you with the ability to process the following (Note: some of these services may be offered to your clients for an additional fee, increasing your profit per client):

  • Eligibility Verification
  • Status of sent file
  • Claims status reports
  • Rejection Analysis Remove and mail paper claims if necessary Secondary claim processing
  • Electronic remittance advice (ERA)
  • Patient declaration services
  • Payment processing reports
  • Transaction summaries and reports of all your clearinghouse activity

A home medical billing and coding business is one that provides physicians with various levels of services and a medical billing information center does the same for the owner of the medical billing business. Make sure you shop around for the medical billing clearinghouses that best fit your needs and budget, but DO NOT choose one strictly based on cost.

Electronic medical billing information centers must provide at least the services I have mentioned above. If you have to wait due to customer service issues at your clearinghouse, you will lose money, your personal and business credibility, and ultimately your valued clients.

Lastly, pay particular attention to the medical billing clearinghouse enrollment and initiation fees that you may have to pay for each professional or practice for whom you are filing claims. Those charges can eat into your earnings. There are medical billing clearinghouses on the market that charge flat fees regardless of how many doctors you bill for now or in the future, so proper research is the best way to keep your clearinghouse expenses to a minimum.