Practice Management Alert

Question: My electronic claims transmission software company just informed me it can no longer process my Medicare transmissions. What does this mean, and what can I do?

California Subscriber

Answer: The problem is most likely with the clearinghouse responsible for relaying your Medicare claims to the local Medicare carrier. Depending on what software system you use, you may be able to choose a different clearinghouse and thereby solve your problem.

First, check to see if your state Medicare program is having a problem with your clearinghouse. Sometimes a Medicare carrier will be unable to process transmissions from a certain practice management system (PMS) or clearinghouse.

Second, you should make sure your vendor and clearinghouse are HIPAA-compliant and able to support and transmit HIPAA-formatted electronic claims. While there's still some time left to become HIPAA-compliant, non-compliant vendors may begin to have problems with carriers that have made the switch.

Third, you should ask your software vendor what other clearinghouses you can use or if you're locked in with the one you have. Some PMSs, such as Medisoft and Medical Manager, have their own clearinghouse, which means you don't have the option of choosing a different clearinghouse. However, many other PMS vendors allow you to choose from a list of different clearinghouses that all work closely with the vendor. This is valuable because it gives you the freedom to switch clearinghouses later on if a problem arises.

Clearinghouse shopping: If your vendor allows you to switch clearinghouses, there are several factors to consider. Of course the first thing to look for is a clearinghouse that will be able to process your electronic Medicare claims without trouble. Once you've made sure of that, you should evaluate prices and available functions.

Note: Stay tuned for more advice on selecting a good clearinghouse in next month's issue of Medical Office Billing & Collections Alert.

-- The answers to the Reader Questions were provided by Eric Goldstein, CEO of Medical Practice Consultants LLP, in Atlanta; Terri Fischer, CPC, CMC, senior consultant with Health Care Group in St. Louis, Mo.; and Wayne J. Miller, attorney with Compliance Law Group in Los Angeles.