Clearinghouse Fees’ Effect on Bottom Line

Clearinghouse Fees’ Effect on Bottom Line
Effect on Bottom Line

Medical billing clearinghouse fees are fees that are added on to contracted fees by most EHR software providers who process claims on behalf of healthcare providers.1 It can be quite difficult for a healthcare provider to work out what clearinghouse fees’ effect on bottom line will be. The following are some important aspects to take into consideration.

Efficiency and Cash Flow

Medical billing and coding can be quite complex, and it is easy for an inexperienced coder to make errors when submitting claims for payment. Any inaccuracies in a claim will result in a delay in payment while the problem is rectified. Even where a healthcare provider has one or more staff members dedicated to billing, the system can become bogged down if errors are frequent, and this can disrupt cash flow. Providers could also face financial penalties for breaches of HIPPA regulations.2

While healthcare providers may balk at paying fees to clearinghouses, the clearinghouses are better positioned to ensure claims are properly formulated before being submitted, speeding up payment. Clearinghouses will be compliant with HIPPA.

Cost of In-House Billing

Most healthcare service providers will need to employ dedicated personnel to manage billing in-house. They will have to invest in infrastructure, such as office space and computer terminals. There will likely be ongoing expenses for sending personnel to training courses or arranging in-house training, as well as taxes, healthcare provisions and other employment costs. All of these costs can amount to a substantial figure. The total cost of in-house billing may exceed the fees paid to clearinghouses.

Other Factors

Using in-house billing obliges you to keep abreast of legislative and administrative changes. That is not the case when you use clearinghouses. Clearinghouses can also reduce the amount of data entry your practice needs to do.

If an in-house biller leaves your employment, you will have to go through the process of recruiting a replacement. This can take time and money and distract other staff from their normal duties. This is something else that must be thought about when determining clearinghouse fees’ effect on bottom line.

Reducing Clearinghouse Fees’ Effect on Bottom Line

To reduce costs, it is necessary to analyze the types of service that make up the bulk of your health service’s claims and shop around for clearinghouses that have the best deals for handling those types of claim. Your medical billing software should provide you with the analytical tools you need to get the information you want. If not, consider upgrading or changing the software.

It can also help to choose clearinghouses that deal directly with the payers to whom you most often send bills. If your clearinghouse does not deal directly with the payers you most often use, claims will be dealt with more slowly. This is because your clearinghouse will have to forward your claim through another clearinghouse that does deal directly with the payer. You can reduce your clearinghouse fees’ effect on bottom line by choosing one that best suits your service. An ideal option is to use an EHR system, such as Integrity Support’s Checkpoint, that handles the clearinghouse for you. Integrity Support covers clearinghouse fees for their clients.


References:

  1. http://www.mb-guide.org/medical-billing-clearinghouses.html
  2. https://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm