A medical billing clearinghouse is an intermediary that helps streamline communications between healthcare providers and healthcare payors. This includes checking billing claims for errors and enabling interoperability of various software systems. Behavioral health practices can cut down on errors, lost money, and manual data entry by using a clearinghouse, especially if integrated directly into the practice’s electronic health records (EHR) software. Medical billing clearinghouses help facilitate processing of billing claims and are designed to comply with the Health Insurance Portability and Accountability Act (HIPAA).
What Is a Clearinghouse?
A medical billing clearinghouse is a service provider that receives electronic claims from healthcare providers, translates them into a standard computer format, screens them for errors, submits them to the relevant payors, and provides the payors’ responses back to the healthcare providers, usually as an electronic remittance advice (ERA). Clearinghouses may also help your practice verify patients’ insurance information in real-time, as well as calculating their deductibles, co-pays, and/or co-insurance responsibilities. These services are all essential to the healthcare industry’s claims processing cycle. They are now typically done electronically, although a clearinghouse may also assist with submitting or receiving information by postal mail, in rare instances.
A core function of the medical billing clearinghouse is electronic data interchange (EDI). As a middleman, the clearinghouse connects with your behavioral healthcare practice and with benefits providers, such as insurance companies, to translate data into a standard format that can be automatically imported and exported into various software. This cuts down on manual keying of data and reduces the potential for data entry errors.
Two examples of medical billing clearinghouses are Waystar and Change Healthcare.
HIPAA-Compliant Clearinghouse Software for Behavioral Health Practices
Besides the numerous other benefits of using a medical billing clearinghouse, HIPAA compliance is an important item that can be put at risk if your staff manually handles billing claims. Clearinghouses’ reputations are staked on patient privacy and protection. Their services include encryption, data access controls, and audit trails, as well as transmitting information on a need-to-know basis, to give payors the information required to process a claim without violating patient privacy. This helps your practice maintain compliance and avoid lawsuits, fines, and other reputational risk.
Pairing a clearinghouse’s services with a HIPAA-compliant EHR, such as Valant, helps further secure your patients’ information by ensuring patient information is protected at all times, including not just medical claims, but also progress and therapy notes, payment information, and more. Valant uses EDI and other technology to directly connect with major clearinghouses, reducing the risk of data leakage from manual keying, copying, importing, or exporting of data.
Streamline Claims Processing With a Clearinghouse
The medical billing claims process can be frustrating and time intensive. There are many different potential insurance plans and other payors to deal with, requiring planning and follow-up to keep track of. Correct knowledge of the patient’s benefits and payment responsibilities, accurate coding of claims, posting payments to patient accounts, and following up on denied claims are all critical to the success of your behavioral health practice, but they are difficult to implement on a consistent basis without the right software.
A medical billing clearinghouse, coupled with a robust EHR, can ensure accuracy, reduce errors, and streamline the claims process. This results in a more consistent and reliable revenue cycle and higher patient satisfaction. For most practices that accept insurance, a clearinghouse is considered an essential tool for billing and a requirement to reduce the workload of your office staff.
Conclusion
For the above reasons, medical billing clearinghouses have become a key part of the medical industry. Many behavioral health providers have come to rely on clearinghouses as a critical link with payors, reducing confusion, delays, and errors while increasing their percentage of paid claims. We encourage you to learn more about clearinghouses and how EHR fits into the process.
Valant integrates directly with two leading clearinghouses and offers a full suite of specialized behavioral health billing tools. Call us today to learn more!
