Health Systems + Hospitals, Physician + Specialty Practices / January 25, 2019

Understanding clearinghouses: why the back end of your PM system matters

The adoption of practice management systems and electronic health records continues to grow  as practices of all sizes look to optimize operations and benefit from reimbursement incentives. In fact, according to a HISS Analytics study, 92 percent of hospital-owned facilities and 78 percent of free-standing outpatient facilities report using these tools.

But while much has been reported and talked about the PM and EHR systems, very little is discussed about a key piece of the reimbursement puzzle: the clearinghouse.

What is a clearinghouse?
A clearinghouse is the connection point between healthcare providers and payers (insurance companies and government payers). It takes information from your practice management (PM) system, checks for errors and delivers claims to your payers in a secure, HIPAA-compliant way. A good clearinghouse integrates with both your PM system and the payer’s software, so that the two software systems on either side can communicate through electronic data integration (EDI). This increases efficiency and reduces your chances of submitting incorrect claims to payers.

Do I have a clearinghouse?
If you haven’t selected a clearinghouse separate from your PM system, you may have one that came bundled with your PM software. It’s important, however, to research your clearinghouse the same way you did your PM system to make sure you’re getting the most out of your existing software and your team’s time.

Why your clearinghouse needs to work well with your PM system
When your clearinghouse integrates tightly with your PM or billing system, you’ll see greater efficiency across your revenue cycle. Below are just a few benefits that result from a smooth relationship between your PM system and clearinghouse:

  • Decreased manual work to exchange information between your software and the payer’s software
  • Streamlined claims workflows
  • More transparency of claims management with closed-loop data analytics
  • Automatic eligibility checks within your billing system
  • Optimized patient collections

Select the clearinghouse that best suits your needs
The right clearinghouse can make all the difference in your revenue collection—and in your team’s productivity and satisfaction. Waystar creates a seamless exchange of claims, remits and eligibility information and integrates with all major PM systems. Achieve a 98.5% first-pass clean claims rate and rely on our friendly, knowledgeable in-house client support whenever you have a question. That’s why Waystar has been ranked Best in KLAS Clearinghouse and Claims Management solution for Physician Practices every year since 2010.

Conclusion
A clearinghouse that integrates well with your existing PM system will make your claims process more efficient and accurate on the first pass, helping you collect more in less time.

For more information
To learn more about Waystar’s clearinghouse, visit Waystar.com.

If you use Greenway Intergy as your PM system, we just released a seamless integration that can help you reach your full rev cycle potential. Learn more here.

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