Why is it important to have an Integrated Clearinghouse? It’s all about transparency. One issue that physicians around the country agree on is the lack of transparency in their billing. And you would think that if the doctor has in-house billing, that the transparency is there. Not so. When your billing system has no capability of transparency, your billing issues can be hidden, right in your own office.
So the question is: what is your lack of an integrated clearinghouse costing you?
Below is a true example of one issue of non-transparency within a practice. The case below reflects a reworking of a denied claim due to the lack of real-time eligibility.
It costs your practice roughly $25 to rework a denied claim due to an eligibility issue. Adding insult to injury, do you know that having to rework a denied claim can actually put you in the negative?
To put it simply: A $130 claim is filed. After adjustments have been made, you are allotted a payment of $55 minus the total cost of the provided service ($29) and cost of billing ($6). Your net profit is: $55 – $35 = $20.
Simple math tells you that if your net profit of a $130 claim is $20, and the average cost of reworking that claim is an additional $25, you are going into the hole.
In other words, depending on the claim rework costs, denial amount, and repeat denial odds or claim rework efficacy, it may be in the provider’s best interest to minimize losses by abandoning the denied claim instead of working the denial. But this does not give you the money you have earned.
Insanity: doing the same thing over and over again and expecting different results. Albert Einstein
So how do you get off of the merry-go-round?
Our philosophy: process claims right the first time and provide complete transparency to the physician.
Because our clearinghouse is integrated within the practice management system, our real-time eligibility request allows two things at one time. With the click of a button, you can verify the patient’s insurance and also create the patient’s chart.
Imagine the time saved by avoiding retyping patient demographics and the time saved by not resubmitting a denied claim because of a typing error.
Integra Medical Business Resources offers RCI: Real-time Cloud-based Integration. Our direct clearinghouse integration offers you a seamless user experience and complete transparency. We are proud to be one of a few billing companies to provide a practice management, EMR, and clearinghouse as a totally integrated solution.