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signs it’s time to change
healthcare clearinghouses

A recent study estimated that up to 25%
of spending in healthcare was wasteful,
with administrative costs making up the
largest category of that waste.

A healthcare claims clearinghouse can help eliminate a lot of this waste. However, once providers change clearinghouses and implementation is complete, the same system is frequently left in place — regardless of evolving technology and the shifting healthcare landscape.   

It’s an understandable side effect. Once a technology decision is made and you actually change healthcare clearinghouses, it’s easy to lose sight of the system’s effectiveness as other projects finally come back to the forefront. Or, if you’ve been with the same healthcare claims clearinghouse for a while, it can feel daunting to evaluate the field and change clearinghouses (perhaps again) — even though the right partner should make that easy (and the right solution will show ROI in short order). 

If you think it might be time for your organization to change clearinghouses — perhaps to a true RCM partner — here are 12 signs it’s time to make the switch. 

Note: This post was originally published in July 2021 but was updated in June 2023.


Your organization is growing, but your profits aren’t

You might consider volume growth a success on its own, but a look at your cash flow tells a different story. Growth often demands more resources to handle a larger volume of patients, and strategic technology investments are critical. The right payments and administrative tools can help your staff tackle a new, larger workload more efficiently. If your vendor doesn’t empower you to take on more patients and collect more reimbursement — without adding headcountconsider a change in healthcare clearinghouse.  


Your staff spends hours on the phone with payers

Manually checking in with payers for a status update will takes 19 minutes per claim on average. That adds up to a whole lot of time wasted by team members making calls or checking websites. An advanced RCM partner can automate status checks and notify your team only when there’s an exception to be remediated. If your clearinghouse can’t help staff get — and stay — off the phone, it’s time to consider alternatives. 


You know something isn’t right, but the root cause isn’t easily identifiable

There’s nothing more frustrating than knowing there’s a problem in your revenue cycle and not being able to pinpoint the reason. If you don’t have visibility into root causes, you can’t make informed decisions to drive improvement. 

You need an RCM partner with powerful data analytics capabilities — a platform that makes it easy to pull, analyze, and share key data points with stakeholders throughout your organization. Not only can this help you more proactively identify problem areas within your revenue cycle, but it can also help you make more informed decisions related to your greater business objectives. If your partner doesn’t prioritize visibility, change healthcare clearinghouses. 

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Your team doesn’t get the support they need

Whether you’re implementing a new solution or you’re in the middle of a crisis and need immediate action, you must be able to count on a client support team that’s responsive and appropriately staffed. That means it’s run by experts who know the solutions you use inside and out — and also understand the challenges your organization is facing.  

Remember: when you sign with a healthcare claims clearinghouse, you’re trusting that vendor with your patients’ health information, your financial goals, and more. The stakes are high, and if you don’t feel like you’re getting a true RCM partner — one that understands all of this and offers white-glove client service — it might be time to see what else is out there. 


Your organization still relies on paper, fax + snail mail 

Studies show that 90% of providers still rely on paper, manual processes and fax machines. Despite advances in AI and RPA, many feel their options are limited by a reliance on outdated tech, manual processes, and administrative paperwork. But it doesn’t have to be that way. 

Imagine being able to completely automate claim status checks across all payers. Or being able to save $9.15 by switching from manual to electronic claim status inquiries. It’s all possible — and painless to implement — with the right revenue cycle partner. 


You have to manage multiple vendors + systems

When you need to expand capabilities, can your partner make that happen? Or do you have to seek and manage multiple vendors with separate logins and interfaces? Juggling too many vendors and managing multiple systems can lead to inefficiency, added security risks, and siloed workflows.   

If you decide to change clearinghouses, look for one with advanced capabilities so that, even if you don’t need them today, they’re available to you down the road. Consider a smart platform with a single sign-on, one that lets you manage commercial, government, and patient payments all in one place, or whatever feature you know would empower your team to be more productive. 


New staff members can’t get up to speed quickly

Training new staff members is time-consuming — especially when hiring is a challenge in and of itself. That means it’s never been more critical for the onboarding process not to take critical time away from higher value tasks. 

The best clearinghouses will help you alleviate those issues by providing user-friendly interfaces, functional workflows, and self-service training resources. Not only does this cut down on the need for lengthy training sessions, but it also puts your staff in a position to learn by doing, become more self-sufficient, and achieve better results. 

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You spend a lot of money outsourcing self-pay collections but you’re not seeing ROI 

As patient financial responsibility increases, many organizations are choosing to outsource patient-pay collections to third-party firms. And many also find it difficult to manage these relationships. 

If you do use third parties for these services, ask your RCM partner if they have tools to help you achieve deeper visibility into how collection agencies are performing. The best healthcare claims clearinghouses will offer tools to help you ensure commissions are correct, see how agencies stack up against one another, and even determine if it would be more cost-effective to reprioritize or bring certain balances back in house.


Your patient mix has changed + you’re seeing more self-pay

As more financial responsibility shifts to patients, you need to be able to consistently identify all billable coverage and maximize collections. You need to be able to quickly verify insurance eligibility, uncover active insurance patients may not know they have, and automatically screen patients to see if they qualify for charity care. 

Most importantly, you need to deliver the convenient payment experience patients have come to expect as consumers. If your vendor isn’t actively helping you adapt to the new patient payment landscape, that’s a clear sign it’s time to change healthcare clearinghouses. 


You want to provide a better experience for your patients

Did you know that patients today are more worried about the cost of healthcare than they are about the quality of care they receive? That fact, uncovered by a Waystar survey, shows that it’s never been more important to offer patients a convenient, compassionate experience.  

You need a platform that allows you to communicate clearly and thoughtfully throughout the payment process. You need to offer accurate estimates of patient responsibility before the point of care. And you need to deliver clear statements through patients’ preferred channels (email, text) while providing modern, convenient ways to pay (credit, debit, Google Pay, Amazon Pay). If your RCM partner isn’t being proactive about patient payments, find one that is. 

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You want to leverage AI + robotic process automation (RPA) 

Artificial intelligence can automate tedious tasks throughout the revenue cycle, from generating estimates to finding hidden coverage, preventing denials, and much more. These capabilities are now the norm, to some degree. If your clearinghouse doesn’t offer AI-powered technology that’s purpose-built for the revenue cycle, look elsewhere.  

And remember: When it comes to getting the most out of AI, technology is just one piece of the puzzle. Many healthcare claims clearinghouses claim they have AI capabilities, but they may not have the combination of technology, data volume, machine learning, and human expertise that powers true automation. Your vendor also needs access to a large amount of data to fuel their intelligence engine, and they should have in-house data-science expertise to know how and when to deploy AI vs. a standard bot. 


You know you need a change but aren’t sure it’s worth the risk

Will it really be worth it to change healthcare clearinghouses? That’s the million-(or-more)-dollar question. Many revenue cycle leaders fear they’ll make the switch only to find themselves in the same place, having lost serious time and dollars during implementation. However, if you do your homework, the chances of this are slim. 

The clearinghouse vendors you’re evaluating should be able to do more than talk the talk. Ask them to back up their claims with proven results, case studies, and client testimonials. Request details about the implementation process, client support, and product roadmap. You’ll know you’re on the right track when the RCM partner you’re considering is upfront — and even excited — to share this information. 

Deciding to change clearinghouses may seem daunting, but with the right partner, you’ll have a seamless experience that pays off quickly and long term. 

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Ready to change healthcare clearinghouses? 

If two or more of these signs sound familiar, it’s time to explore what else is out there to help you manage your revenue cycle.  

Waystar provides user-friendly solutions and award-winning support to more than 1 million providers across the country. Click here to learn more about how we make the switch easy — and worth it. 

Make the change