Switching Clearinghouses: Should I Stay, or Should I go?

Switching to a new clearinghouse can seem like an overwhelming process. Yet, it is vitally important that you choose a clearinghouse that is the right fit for your organization since your connection to the clearinghouse is an essential part of your daily operations and critical to your revenue cycle.

Will my connections to payers be disrupted or lost when we switch?

The last thing your team wants to do is waste time manually reconnecting to payers. This is one of the biggest concerns for organizations that are considering making a switch. Providers are often hesitant about trying another clearinghouse, even if the new clearinghouse has valuable and enticing features because they aren’t sure about the actual costs they’ll incur from switching.

To avoid the administrative burden associated with manually reconnecting to payers when transitioning, be sure to check whether the new clearinghouse has a policy where they will reconnect you with payers as part of their included set-up and implementation process.

Question to Ask Yourself: Evaluating your current vendor—what don’t you know?

Evaluate your revenue cycle. Are you able to determine what issues your revenue cycle is currently experiencing? Can you pinpoint the causes of these issues? Do you have any blind spots? Shine the metaphorical light into all the corners of your revenue cycle to find out what your problem areas are.

If you don’t know the exact issues with your billing cycle, then changing clearinghouses will simply transfer your issues instead of resolving them. Do your best to highlight your blind spots before you switch to ensure that your new clearinghouse will be able to help you.

How happy are you with your current clearinghouse’s level of customer support and service?

[When you rely on a clearinghouse to process your claims, you’re also depending on their support team to address any problems quickly. When a vendor isn’t efficiently resolving support requests, then the resulting slowdown could negatively impact your revenue cycle and reimbursement rate. Ask about the new clearinghouse’s abilities and their strategies for resolving customer issues before you make the switch.

What type of functionality do you need from a clearinghouse?

Will you only be using your clearinghouse to connect with payer platforms, or does it also need to integrate with your practice management or hospital information system?

Not every provider uses their clearinghouse the same way.

Some clients may prefer a hybrid approach where they use specific features and workflow tools in tandem with existing systems, while others may favor using a single-sign-on solution that allows them to handle the entirety of their revenue cycle from end-to-end.

A comprehensive clearinghouse should offer a variety of solutions that allow users to choose the ways that they engage in the partnership. These solutions should assist you with working on your revenue cycle and should include tools that help you with tasks such as:

  • Claims management (scrubbing, validation, claim edits, etc.)
  • Converting paper EOB’s to ERA’s
  • Detailed reporting and analytics
  • Eligibility verification
  • Patient estimation and payment options
  • Rejection and denial management tool analysis
  • Remit management
  • Workflow management and customization

You want to ensure that whichever clearinghouse you choose to partner with offers different forms of functionality to fit the needs of your business as they are now, but also the potential needs of your business in the future. These is always a possibility that if you’re using a hybrid method now, you may need to move to a more fully-integrated solution in the future. As your needs change over time, it is ideal that whichever clearinghouse you choose to partner with will adapt with you.

Is your current clearinghouse making you more productive?

The main reason organizations partner with a clearinghouse is so that you have a higher clean claims rate, can submit your 837’s more quickly and efficiently, which means that you get reimbursed in a timely manner. Unfortunately, many providers are still forced to deal with managing rejections and denials when they should be working to prevent them before the occur. Clearinghouses will typically offer reporting options and insight into denied claims. However, if your denial rate is still above average, then it may be time to consider switching to a clearinghouse that offers more robust scrubbing and editing capabilities to help you lower your denial rates.

Clearinghouses help you to maintain a higher clean claims rate, so if you’re still experiencing a high volume of denials, then it’s possible that the clearinghouse you’re currently using isn’t the best fit for your needs.

Final Considerations

Make sure to review your current revenue cycle to find any blind sports and to identify your pain points before making the switch. Identifying these will help to clarify what you need from a clearinghouse and whether or not a particular vendor will be the right fit to meet your needs.

Don’t be afraid to ask questions!

If you’re at the point of considering making the switch, make sure that you don’t rush the process. This is a big decision, and it’s important to make sure that you have all the information you need. What time of support do they offer? What are the costs associated with the new clearinghouse that differ from your current vendor? What’s your budget like?

Don’t settle for a clearinghouse that is “better”—choose the clearinghouse that is the best for you. While the questions and considerations outlined in this article may be able to guide you during your selection, it is always best to practice to continue to inquire about any new vendor that you may be considering partnering with so that you can find the best fit for you and your oganization.

More questions than those listed here? Reach out to one of your reimbursement experts to learn more.

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