Maximize Revenue FAST – Step-Up the Use of Your Clearinghouse

EDI clearinghouses have been around since the 1990s, and today they offer far more than just electronic claims submission. Yet, practices have been slow to adopt many of the clearinghouse services that can save significant time and money.

“We are still amazed at the small number of hands that go up in our workshops when we ask whether practices are set up for batch eligibility, electronic remittance, electronic funds transfer, and real-time claims adjudication,” says Karen Zupko. “Practices that don’t use clearinghouse services such as these are missing a big opportunity to reduce accounts receivable and speed payments.”

• For pennies per transaction, clearinghouses allow you to validate patient eligibility. Some integrate with your daily appointment schedule, automatically verifying information overnight.
• Electronic remittance eliminates the time-consuming task of manual payment posting, giving reimbursement staff more time to follow up on unpaid claims.
• Real-time claims adjudication allows you to bill insurance at the time of service. The payor adjudicates the claim in real time, and staff receive an immediate response about the allowed amount and patient portion of the bill while the patient is still standing at the check-out window. Out-of-pocket amounts can be collected right then – no waiting for insurance to pay, or to send a statement. Staff can collect deductible and coinsurance amounts before the patient leaves the office.
• Claims editing and error management runs your claims through ‘rules engines’ that catch errors at the time the claim is submitted – allowing staff to correct them quickly, and speeding payment turnaround time.
• Electronic funds transfer tightens audit control because payments are sent directly to your bank account.

“Given the current economic times, there’s never been a better time for process automations like these.” Karen says.

RealMed® and A-Claim are two clearinghouses to consider. RealMed® was recently ranked first of fifteen EDI clearinghouses in the 2009 KLAS Ambulatory Clearinghouse Services Report, “Managing the Claim and Getting Paid.” KLAS is a research firm that monitors and reports the performance of healthcare vendors such as clearinghouses, and publishes an annual ranking report.

One A-Claim customer reports that the company’s services have reduced the time it takes to gather vital information from insurance companies from 20-30 minutes to 60 seconds. Data from RealMed’s® customer studies indicate that:

• An 8 provider practice in the Midwest reduced its administrative staff by 1, saving $33,000 a year.
• A large academic facility used batch eligibility to remove the need for 6 FTEs previously devoted to checking patient benefits. Annual savings: $198,000
• A large multi-specialty group went from auto posting auto posting approximately 40% to more than 85% of all claim volume. Significantly saving staff time.

Download this Implementation Checklist and maximize the use of clearinghouse services in your practice today.

What has been your experience with EDI clearinghouse services? Have they reduced A/R or expenses? Do they work ‘as advertised?’ Send your comments to: kza_alert@karenzupko.com.

For more information visit www.karenzupko.com or call (312) 642-5616.