Medical
Billing Clearinghouses - A Key to Processing Efficiency
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Medical Billing Clearinghouses are rapidly becoming a larger
and larger part of the healthcare reimbursement landscape. Basically,
billing clearinghouses are organizations dedicated to electronic
healthcare claims processing and reimbursement. Most independent
billing companies and specialists rely on an established clearinghouse
to process their healthcare reimbursement claims.
As a general rule, clearinghouses depend on economies of
scale to operate efficiently. In other words, by processing
millions of claims each day or week, a clearinghouse is able
to drive its average cost per claim down to a very low level.
It would be extremely cost prohibitive for an independent
billing organization to deploy the necessary resources to
accomplish all of the detailed quality assurance activities
that are required to meet minimum reimbursement standards.
Most billing companies and practitioners find this to be an
invaluable service. It turns out that being out of compliance
in the healthcare reimbursement arena can lead to steep fines
or even criminal penalties, particularly when dealing with
a government reimbursement organization such as Medicare or
Medicaid. For this reason, most independent billing specialists
choose to transfer a portion of the workload as well as a
portion of the liability for their claims processing activities
to large medical billing clearinghouses. This is wise, providing
the right clearinghouse is selected.
In addition to quality control functions, the clearinghouses
specialize in converting claims submitted by an independent
billing company or specialist into a format that is recognized
by the various healthcare reimbursement organizations: government
agencies and a multitude of different insurance companies.
Most billing clearinghouses charge some kind of setup fee
to add an independent billing specialist as a new client.
Also, they normally charge a small fee for each claim that
they process. Some clearinghouses only charge for certain
claims processing services. Often they will charge more for
a Medicare claim, as the claim processing requirements are
more stringent when government dollars are involved. While
medical billing companies and practitioners can benefit substantially
from the services of a medical billing clearinghouse, it is
wise to carefully evaluate all of your options if you get
to a point where you feel you could benefit from the services
of a medical billing clearinghouse.
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