Medical Billing Clearinghouses are rapidly becoming a larger and larger part of the medical billing landscape. Basically, medical billing clearinghouses are organizations dedicated to electronic healthcare claims processing and reimbursement. Most independent medical billers rely on an established medical billing clearinghouse to process their medical billing claims.
Medical billing clearinghouses depend on economies of scale to operate efficiently. In other words, by processing millions of claims a day or a week, a clearinghouse is able to drive their average cost per claim down to a very low level. It would be cost prohibitive for an independent medical biller to accomplish all of the detailed quality assurance activities that are required to ensure that each claim meets minimum reimbursement standards. Being out of compliance in the healthcare reimbursement arena can lead to steep fines or even criminal penalties, particularly when dealing with a government reimbursement organization such as Medicare or Medicaid. For this reason, most independent medical billing specialists transfer a portion of the work and a portion of the liability for accuracy to large medical billing clearinghouses. This is wise, providing the right clearinghouse is selected.
In addition to quality control functions, the clearinghouses specialize in converting a an independent billing specialist’s generic formatted claims into a format that is recognized by the various healthcare reimbursement organizations, such as Medicare, Medicaid, and a host of different insurance companies.
Most medical billing clearinghouses charge some kind of setup fee to establish an independent biller as a new client. Also, they normally charge a small fee for each claim that they process. Some clearinghouses only charge for certain claims processing services. Often they will charge more for a Medicare claim, as the claim processing requirements are more stringent. It is wise to do your homework and consider all of your options if you get to a point where you feel you need the services of medical billing clearinghouse.