Clearinghouse represents the first step on a reimbursement claim’s journey toward money in a clinician’s pocket, but a lot can happen once it’s transmitted from the practitioner’s office.
In this revealing article, Nitin Chhoda provides an inside look at factors that can affect a claim and the ultimate reimbursement.
A clearinghouse is an essential element of the entire medical or physical therapy billing cycle. They ensure that each claim is routed to the appropriate insurance company for payment.
They perform other useful functions before a patient arrives at the office and afterward. Billers can utilize their services to ascertain a client’s insurance eligibility and coverage prior to treatment. They can also issue a statement of services to patients.
Cleaning the Claim
The first step for a claim after its arrival at the clearinghouse is a thorough scrubbing for errors and inconsistencies. Some mistakes can be quickly corrected online, allowing the claim to continue on its journey. These are typically clerical errors and while they may seem minor, they contribute significantly to the wait time for the claim to be paid.
Other problems aren’t so easily rectified and the entire claim will be returned to the clinician’s office to be corrected and resubmitted. These types of problems can arise when the clearinghouse doesn’t recognize the payer. Many smaller insurance companies don’t accept electronic payments and the claim will be returned, necessitating submission of a paper reimbursement request.
Clearinghouse is responsible for matching payer identification numbers with the right claim, a process that tells the organization where to direct the reimbursement request. The practice’s billing and coding specialist must include the correct payer ID number on the claim or it will be returned to the medical provider, further delaying reimbursement.
Reports and Records
Medical clearinghouse maintains a record of each claim that goes through the facility’s system and generates a status report.
The record can be accessed by the practice and used to monitor the location of the claim, where it was sent and when. Sometimes a claim may seem to disappear. Billers can check their batch report against those generated by the clearinghouse to discover what happened to it.
Clearinghouse provides clinicians with a single location to manage all their reimbursement claims and to do so electronically for speedier payment.
Multiple claims can be submitted at the same time and clearinghouse reports allow clinics to track and monitor the status of any claim 24/7.
Practitioners that contract with clearinghouse have the advantage of fewer rejected and denied claims and quicker reimbursements.