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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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