Providers Need More Than a Clearinghouse to Compete

Advances in technology in all areas of life happen at a furious pace. Smartphones and smart homes are the norm.

One place where technology seems to advance more slowly is the provider’s back office. Claims, denials and patient eligibility continue to be submitted “manually,” although automated technology exists.

Provider offices submitted 119 million claims manually in 2012, compared to 1.1 billion submitted electronically. In 2015, 95 percent of providers and health plans submitted claims electronically. Nevertheless, the remaining 5 percent is a significant number of manually submitted claims.

It’s becoming increasingly difficult to compete in healthcare if the provider’s back office isn’t fully automated. A modern clearinghouse function has evolved, just like other technologies, to become much more than it once was. Today, revenue cycle management (RCM) combines multiple areas related to the practice.

Providers may shy away from RCM operations because they are not a core competency. They’ve trained to be the best at treating patients; they haven’t trained to be the best at submitting claims.

Working with a highly skilled RCM partner ensures providers use the most up-to-date technology, have direct access to thousands of payers and utilize best practices across the board for any revenue cycle related task. The partner keeps track of trends and changes in reimbursement, denials management and patient financial information, freeing up the provider to care for patients. In addition, the partner can easily and economically scale the solution as the practice grows.