Practice Management Alert

Our experts show you how to improve claims transmission and maximize your service

Many billers don't know that when it comes to your clearinghouses, you have choices. And clearinghouses aren't just about simple claims transmission services anymore -- many offer claims management services that could help your office run more efficiently.

You should explore your clearinghouse options whether you're choosing a practice management system (PMS), investigating glitches in your claims transmission, or simply looking for a more efficient way to manage your claims. Our experts share four things your practice can do to ensure satisfaction with your clearinghouse service.

1. Plan ahead: Look for a PMS vendor that allows clearinghouse flexibility. Many PMS vendors will allow you to choose among several clearinghouses that they contract with, says Eric Goldstein, CEO of Medical Practice Consultants LLP, in Atlanta. But other vendors may lock you in with one set clearinghouse. Having the freedom to choose is important because if you start having problems with one clearinghouse you'll be able to make a change, he says.

Your options will totally depend on your PMS contract, says Maria Johnson, CPC, coding supervisor with MedaPhase in San Antonio. If your clearinghouse doesn't offer the service you need, or if it is causing denials or losing information, you may be better off switching to another clearinghouse, she says.

2. Identify the source of your claims transmission problems. While all signs may point to your clearinghouse as the source of claims transmission trouble, internal systemic issues within your PMS could be to blame, Johnson says.

Warning: Don't automatically assume you need to switch clearinghouses if you're having problems with claims transmission. If your PMS is at fault, or if a transmittal problem between your system and the clearinghouse is causing complications, you will probably still have the same problem if you switch clearinghouses, Johnson says.

Investigate first: Uncovering the origin of a problem should be as easy as calling your PMS vendor and your clearinghouse, Goldstein says. You just need to ask questions. Many times the vendor or clearinghouse can run tests to find out exactly where the problem started, he adds.

3. Evaluate your clearinghouse options. Before you make any changes, you should ask your PMS vendor for a list of your clearinghouse options. Then you should determine what you want a new clearinghouse to do for you, Goldstein says. If your PMS and office staff already have a great handle on claims management, you may want a clearinghouse for basic electronic claims transmission service only. However, now that many clearinghouses offer to do everything from statements and collection letters to automatic payment posting, chances are your billing office could reap the benefits of some additional clearinghouse services. Mainly, you'll want to evaluate a clearinghouse's functions and fees, Goldstein says.

Functions: Even if your PMS can provide a particular claims management service for you, "you have to weigh the cost of doing it in-house versus outsourcing to a clearinghouse," Goldstein says. For example, a clearinghouse may save you both time and money by sending statements out for you or performing automated patient reminder calls.

Price: Clearinghouses charge you per claim (for example, 57 cents per claim) and assess an additional charge for each extra page of a claim (for example, 12 cents per page after the first page). Although the price variance may seem insignificant between clearinghouses, the difference between 57 cents per claim and 62 cents per claim (5 cents difference) can add up quickly when you're filing hundreds or thousands of claims per month, Goldstein says.

4. Look to the future of claims management tools. With all the new services available today, limiting yourself "to the traditional clearinghouses would be a tragedy," says Jim Denny, president and CEO of Navicure Inc., a claims management company based in Duluth, Ga. Navicure offers an entirely Web-based solution to claims management by acting as the middle man between your PMS and the various clearinghouses it works with. Navicure's system allows the practice to check where its claims are in the system and to determine exactly where any problems started, Denny says.

Instant gratification: A Web-based solution like this allows you to see instantly which claims a carrier denied and how you can fix them. This makes your claims management much more efficient, Goldstein says. As Navicure users continue to uncover the root cause of their denials, they "begin to eliminate rejections" and have less administrative work on the back end, Denny adds.

Worth considering: This new Web-based type of claims management service will definitely increase in popularity as more practices realize the technological benefits, Goldstein says.