What Is a Medical Billing Clearinghouse, and Should I Use One?

Thousands of the American Medical Association’s CPT codes are utilized in modern medical billing processes, with some codes added, modified, or deleted each year. So many codes undergoing constant change can cause problems — like 80% of submitted medical bills containing errors. These errors can be attributed to many factors, including human error, improper formatting, and mishandled upcoding. Fortunately, the right techstack and supporting team members can improve billing processes and reduce the likelihood of costly mistakes. 

One of the most common solutions medical practices explore is a billing clearinghouse. A billing clearinghouse acts as a middleman that lowers the risk of a practice being negatively affected by issues that impact billing processes. In this article, we’ll explain what purpose clearinghouses serve and whether or not your practice should consider implementing one.

What Exactly Is a Medical Billing Clearinghouse?

A medical billing clearinghouse (MBC) acts as an intermediary between healthcare providers and insurance companies. MBCs provide a secure channel for providers to electronically transmit private healthcare information and insurance claims to insurance providers and patients.

How Does a Medical Billing Clearinghouse Work?

Once a medical claim is ready to submit, the MBC reviews the claim for any errors. This ensures the claim is accurate and properly formatted before submitting it to the insurance company, reducing potential denials.

Clearinghouses help establish “clean claims” and submit them to all appropriate parties. Medical billing can be difficult to follow throughout the lifecycle of a claim, and an MBC promotes simpler workflows, accuracy, and an all-in-one hub for claim review and processing without sacrificing quality control.

What Benefits Does a Clearinghouse Offer Medical Practices?

A medical clearinghouse solves a variety of problems, including:

  • Ensuring payer software meets specific standards
  • Facilitation of nonstandard health information and data elements
  • Providing secure submission of electronic claims
  • Providing standardization throughout the claims process to increase acceptance rates

Healthcare practices will gain access to a simplified claim delivery process while having their processes regulated. Integrating an MBC’s services into your practice management software can provide several features developed by industry experts to clarify and streamline the claims submission process.

1. A Hub of Industry Experts

While billing practice managers can handle claims processes, it’s simpler for a practice to outsource the full process to a clearinghouse. Medical billing clearinghouses comprise an entire hub of industry experts, giving practices access to reliable assistance.

2. Streamlined HIPAA Compliance

Clearinghouses process nonstandard healthcare information and documentation for healthcare and medical organizations. According to HIPAA rules, clearinghouses are covered entities. Therefore, a medical clearinghouse can securely interpret claims data for insurance providers to help remain HIPAA compliant across different networks.

3. Ability to Prevent Claim Rejections

An MBC helps prevent claim rejections by streamlining process workflows. Insurance payers can push back a claim with the slightest error. A clearinghouse can reduce reimbursement times and claim returns and handle the claim process after acceptance.

Solving Problems With Benchmark Solutions

A medical billing clearinghouse allows for an increase in quality assurance and significantly reduces claim errors. This type of integration also relieves healthcare practices of additional billing efforts that take away from other internal operations.

Benchmark PM, designed with clearinghouse integration, offers a streamlined way of boosting clean claims up to 98%. Some of the features that practices will have access to are:

  • Personalized work lists
  • Secure electronic billing
  • Remittance processing
  • Real-time status tracking and monitoring

With these features, healthcare practices can solve their medical claims issues within one platform and increase acceptance the first time around. Request a demo today to see how simple optimizing your medical billing and patient management efforts is when you have the right technology.