Slide Share: 11 Signs You Are Working With an Awesome Clearinghouse

Healthcare organizations are caught in an unusual business predicament: Even as the demand for services increases, profitability is being squeezed by declining payer reimbursement rates, rising operating costs and the increase in patient financial responsibility. Proactive revenue cycle management (RCM) plays a larger role than ever in profitability. Having the proper clearinghouse in place is vital to an organization’s revenue cycle, including all aspects of A/R, patient billing, remittance and appeals. Read on to learn the 11 signs that you’re working with a great clearinghouse.

#1 – It Provides Accurate Eligibility Information: A significant and increasingly larger portion of your reimbursement should be collected at time of service and to do so effectively requires access to current eligibility. Your clearinghouse should provide batch and real-time eligibility solutions with insurance benefit information that staff can verify on the front end to collect patient responsibility and decrease patient bad debt.

#2 – There Are Robust Claim Edits: A strong clearinghouse grows with experience, meaning that every time a claim is rejected by one user, the rejection is incorporated into the edit database – increasing the first-pass rate for every user of the clearinghouse. Better first-pass rates accelerate cash flow and decrease days in A/R.

#3 – Electronic Claims Submissions Have an Immediate Response: Beyond just submitting claims electronically, your clearinghouse should provide an immediate response – in seconds versus days – indicating acceptance/rejection based on claim scrubbers and edits. Pinpointing and correcting front-end rejections online prior to the claim being sent to the payer will improve first-pass rate and reduce denials.

#4 – It Has ERA Connections to Key Regional and National Payers: A clearinghouse with electronic remittance advice (ERA) to both your top national and regional payers allows for automatic posting, freeing up staff time to work on more revenue-generating activities.

#5 – There Are Online ERA Management Tools: Your clearinghouse should enable you to take ERA management further with the ability to categorize and correct denials, manage appeals process, find payments easily and print EOBs for a single patient.

#6 – It Has Electronic Secondary Claims Submission: A robust electronic secondary submission solution brings in all earned revenue without the expensive, time-consuming hassle associated with manual secondary filing. Your clearinghouse should have the necessary connections to the payers plus dedicated secondary edits to ensure faster submission and first-pass rates.

#7 – There Are Denial Management Tools: Unfortunately, even with the best claims scrubber, organizations will never be able to eliminate all denials so it’s important your clearinghouse has tools to manage them. For example, pre-populated appeal letters and denial tracking allows you to track and appeal automatically versus manually.

#8 – It Incorporates Patient Billing: Clearinghouses with automated patient payment solutions can reduce patient billing and collections costs. Look to a clearinghouse with the ability to securely store patient credit/debit card information on file, automate payment plans, and with online billing and eStatements functionality.

#9 – It Provides Actionable Business Intelligence:   A strong clearinghouse has business intelligence tools that deliver metrics that are relevant, integrated and actionable, making it easy to gain insights and resolve issues. You should expect a solution with turnkey dashboads and agile reports in real-time so adjustments can be made to improve cash flow.

#10 – There Are Analysis Tools: Being able to spot rejection and denial trends so that you can make necessary changes to increase reimbursement and improve staff productivity is critical for success. A good clearinghouse provides the ability to do so and aggregate over time to track results of internal changes.

#11 – And It Has Outstanding Client Service: When having an issue with a payer, claim or anything else that could affect your reimbursement, a clearinghouse’ s client service team should help to resolve issues quickly. Look to a clearinghouse with an industry-leading team of seasoned professionals who can resolve at least 95% of problems on the first call or email.

Conclusion: A great clearinghouse streamlines your entire revenue cycle process and is a partner who cares as much about getting your claims reimbursed as you do. To learn more about what to expect from a clearinghouse, download the free white paper today!