Medical Billing - Clearing house, claim scrubber, clean CMS-1500 Claims

Описание: Title: "Clearing House in Medical Billing: Process and Importance"
What is a Clearing House?
• Clearing house acts as a bridge between healthcare providers and insurance companies.
• An intermediary that transmits medical claims from healthcare providers to insurance payers in an electronic format.
• Helps to streamline the medical billing process and reduce errors.
• Can help healthcare providers to improve their cash flow and reduce administrative costs.

Role of Clearing House
A healthcare clearinghouse checks over medical claims for errors or mistakes to make sure the claims can be accurately processed by the payer.
Once accurate claims are received, the clearinghouse electronically sends either an acceptance or denial back to the healthcare provider.
"Role of Clearing House"
Clearing house checks claims for errors and validates them before submission to insurance companies.

Clearing house service provider
• ZirMed
• Gateway EDI
• Availity
• Emdeon
• RelayHealth
• Ingenix
• HealthSmart

How it works:
The medical billing software on your desktop creates an electronic file (the claim) also known as the ANSI-X12 837 file.
The claim is uploaded (sent) to medical billing clearinghouse account.
The clearinghouse then scrubs the claim checking it for errors
Clean Claims are submitted to Insurance
Errors claims are sent back to Medical Billing Software as Rejected Claims

"Importance of Error Prevention"
Allows you to catch and fix claim errors in minutes rather than days or weeks
Results in fewer denied claims and significantly higher claim success.
Rapid claims processing: Filing claims electronically can reduce reimbursement times to under ten days.
Submit all your claims at once in batch instead of submitting them separately one at a time.
Shorter payment cycles lead to more accurate revenue forecasts.
Reduce or eliminate need for paper forms, envelopes and stamps

Clearing house monthly fees:
Many of the best clearinghouses charge between $75 to $95 per month (per doctor or provider)
Slide 7: "Faster Reimbursement"
Clearing houses expedite the reimbursement process, ensuring healthcare providers get paid faster.
Visual: Clock showing the speed of reimbursement.
Slide 8: Modify this image

Show with images/icons etc
Medical Coder reviews and assigns ICD-10-CM, CPT, HCPCS Codes
Medical Biller creates CMS-1500 form with patient demographics and Medical Codes
The created claim is submitted to clearing house
Clearing house submits to insurance.