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Etactics
United States
Registrace 10. 01. 2013
Etactics is a leading business services company committed to providing innovative, web-based solutions that improve our clients' cash management and customer relationships. Our services assist our clients across all our business sectors to improve business processes, boost staff productivity, reduce expenses, and accelerate payment.
What is a Medical Billing Clearinghouse?
When you schedule a doctor's appointment there are three things they typically ask you. Can you guess what they are? If you guessed the name, date of birth, and insurance provider you guessed right. They ask you for this information because it goes into a patient management system. Once the information is added to this system, the revenue cycle begins.
Ever wondered how medical facilities manage patient data, insurance claims, and billing all at the same time? It's all possible because of medical billing clearinghouses. But what exactly is a medical billing clearinghouse?
Let's break it down.
Let's start with just the definition of a clearinghouse. A clearinghouse is an agency or organization that collects and distributes something, especially information. They have the resources to distribute payments, enforce security measures, and monitor transactions or statements. It ensures all elements of a deal or transaction follow the rules and that there's no funny business going on.
Now what is a medical billing clearinghouse?
A medical billing clearinghouse, more often referred to as a medical claims clearinghouse assists medical billers and healthcare organizations in processing and managing thousands of patients insurance claims and billing.
A medical billing clearinghouse is essentially the middleman between healthcare providers and insurance companies. This type of clearinghouse makes sure there are no mistakes in the insurance claims or in the medical bills.
Because medical billing clearinghouses are working with PHI or protected health information, they must follow certain regulations like the Health Insurance Portability and Accountability Act, also known as HIPAA.
Medical billing clearinghouses are important for the provider's profits. The provider is the doctor or medical professional that administers care. A common issue in the revenue cycle of medical practices is denied insurance claims. In 2021, 17% of in-network claims were denied.
A denied claim means a delay in the provider's profit. You wouldn't want to work for free right? Didn’t think so. This is why a clearinghouse is so important. If a claim gets denied, it needs to be corrected, submitted and go through the approval process again.
But, this process can take anywhere from 15 to 45 days. Meaning if a claim is denied even once, the provider will experience a significant delay in receiving revenue.
Denied claims result in huge revenue loss, even if they’re approved upon resubmission. Besides, handling denied claims consumes more time and energy compared to getting them approved the first time. So you might as well do it right the first time and utilize a clearinghouse.
A Medical billing clearinghouse's goal is to not only help with the submission of claims, but also minimize denied insurance claims to maximize the provider's profits. Clearinghouses shrink the number of denied claims through claim scrubbing. Claim scrubbing is the validation checks the clearinghouse performs before it is sent to the insurance provider…almost like a spell check! This improves the claim's odds of getting approved and the provider gets paid on time!
Have you ever waited for months to see your primary care doctor or dentist? I know I have. Now imagine if your doctor had to do hours and hours of paperwork after each patient. If this was part of their job description, you would never get that appointment.
Regardless if you’re a payer, provider, or just a patient, you’re a part of this never-ending cycle. Now you see how much of a necessity a medical billing clearinghouse is.
►Reach out to Etactics @ www.etactics.com
►Subscribe: rb.gy/pso1fq to learn more tips and tricks in healthcare, health IT, and cybersecurity.
►Find us on LinkedIn: www.linkedin.com/company/etactics-inc
►Find us on Facebook: etacticsinc/
#MedicalBilling #Clearinghouse
Ever wondered how medical facilities manage patient data, insurance claims, and billing all at the same time? It's all possible because of medical billing clearinghouses. But what exactly is a medical billing clearinghouse?
Let's break it down.
Let's start with just the definition of a clearinghouse. A clearinghouse is an agency or organization that collects and distributes something, especially information. They have the resources to distribute payments, enforce security measures, and monitor transactions or statements. It ensures all elements of a deal or transaction follow the rules and that there's no funny business going on.
Now what is a medical billing clearinghouse?
A medical billing clearinghouse, more often referred to as a medical claims clearinghouse assists medical billers and healthcare organizations in processing and managing thousands of patients insurance claims and billing.
A medical billing clearinghouse is essentially the middleman between healthcare providers and insurance companies. This type of clearinghouse makes sure there are no mistakes in the insurance claims or in the medical bills.
Because medical billing clearinghouses are working with PHI or protected health information, they must follow certain regulations like the Health Insurance Portability and Accountability Act, also known as HIPAA.
Medical billing clearinghouses are important for the provider's profits. The provider is the doctor or medical professional that administers care. A common issue in the revenue cycle of medical practices is denied insurance claims. In 2021, 17% of in-network claims were denied.
A denied claim means a delay in the provider's profit. You wouldn't want to work for free right? Didn’t think so. This is why a clearinghouse is so important. If a claim gets denied, it needs to be corrected, submitted and go through the approval process again.
But, this process can take anywhere from 15 to 45 days. Meaning if a claim is denied even once, the provider will experience a significant delay in receiving revenue.
Denied claims result in huge revenue loss, even if they’re approved upon resubmission. Besides, handling denied claims consumes more time and energy compared to getting them approved the first time. So you might as well do it right the first time and utilize a clearinghouse.
A Medical billing clearinghouse's goal is to not only help with the submission of claims, but also minimize denied insurance claims to maximize the provider's profits. Clearinghouses shrink the number of denied claims through claim scrubbing. Claim scrubbing is the validation checks the clearinghouse performs before it is sent to the insurance provider…almost like a spell check! This improves the claim's odds of getting approved and the provider gets paid on time!
Have you ever waited for months to see your primary care doctor or dentist? I know I have. Now imagine if your doctor had to do hours and hours of paperwork after each patient. If this was part of their job description, you would never get that appointment.
Regardless if you’re a payer, provider, or just a patient, you’re a part of this never-ending cycle. Now you see how much of a necessity a medical billing clearinghouse is.
►Reach out to Etactics @ www.etactics.com
►Subscribe: rb.gy/pso1fq to learn more tips and tricks in healthcare, health IT, and cybersecurity.
►Find us on LinkedIn: www.linkedin.com/company/etactics-inc
►Find us on Facebook: etacticsinc/
#MedicalBilling #Clearinghouse
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Got this once, very hard to outrun
I need help about patient Privacy
I find it incredibly shady that an expert can’t explain this “Complex topic “ but seniors are supposed to be able to understand it.
Good job
Is this relevant for lawyers?
that’s my bday
No need to celebrate about this 😨
MAYFIELD UNITED METHODIST CHRSTERLAND OHIO CANTRALL HELP MUDAUGHTER
Is sharing ss# with 3rd party a violation?
I got this and fixed it somehow idk how but I did it
There's an anime movie about this, tho they change the cause abit but the virus it self was there.
Great Content!
Sad thing is.... HIPAA does not cover all entities. And with all the nonprofit providers now handling databases for 'research and statistical data' ..... it seems like a very fine line, whereas nonprofits or 3rd parties are compiling data for their customers (medical entities and/or agencies, etc.). Does HIPAA need to update their penalties for these 3rd parties that work for other entities? Yes, these nonprofits may sign the contract that defines adherence to privacy etc, but many 3rd parties hire low wage people that come and go and some that are tucked into universities use students as interns to handle statistical data. These youngins haven't a clue on privacy or HIPAA and do not understand the significance of gossiping about data. So, who enforces 3rd parties that work for agencies? What kind of data is being shared with these 3rd parties ? Are identifiers redacted? If one has been to a doctor recently, take the time to read their privacy statement next time you visit their office. If I ask them to opt me out of selling data, in which we have the option of doing so, the system defaults to opt me in and the young ladies at the front desk look at me like they are on cloud 9 and tell me they cant opt me out (they have no clue) . Many doctors now sell all patient data to a research company, then I started being influxed with mailers, calls, etc from other 3rd parties. Talk about privacy!!!!!!???? Who is paying the 3rd parties to compile data? Is this project used with our tax dolllars?! All about money.
The video is not scary at all the intro is💀💀💀💀
This biggest violation of all is not even on the list. Unless it's legal, and if it is, HIPAA is a sham. I want to know why HIPAA is not preventing the DEA from physically going into doctors' offices and demanding (and receiving) people's PHI? As I understand it, this requires my signature, which I will never do. This harassment is a reality for EVERY doctor in America who writes a pain medication prescription. I expect doctor - patient privilege, and the Feds need to back off. Now.
My wifes mother is a nurse in the local medical clinic ER. A friend went in for cellulitis. She told him she knew he got it at (the house ny wife and i were staying) and that he got it from sexual activities with us, (It didnt happen...but he did stay a few nights with his girlfriend)....but that is when it got even creepier.... I actually had celulitis although its not transmitted sexually FYI ... but it was HOW DID SHE KNOW ??! She told ny friend that ... "I have people out watching my daughter and that man" .... Her mom is a covert narcissist pedophile prep groomer (for her father)..... and in true form of a narcissist I knew how she would react if a scenario presented itself .. without making this too long ...i floated rumors about us swinging knowing how she would react. . One bad part. She withheld this reaction until she could move me out of the way. .. because she knew i was on to her. She literally got someone to mindscrew my wife into leaving me. As soon as i was out....her mom, emboldened started shooting off like i explained above.... Did ger sharing health related info about us our sex life etc is that a hippa violation?
Cheer~~~identify the nature of (an illness or other problem) by examination of the symptoms.😊
I am working in medical billing and this is very helpful. Thank you for sharing.
Postal Stamps are forever for us, always!
Wow more denails explanation please
Where are your resources on the statistics from?
Ma'am you teached very well thanku for your effort 🎉
Companies have gotten away with this for decades. The only solution that I can see, is government imposed hiring quotas, requiring a certain percentage of workers at any company where the job is appropriate, to be people 50 and over. It's largely worked for Women and Minorities, it can work for aged people too. Another thing that would help is universal health care. That would get that burden off the backs of employers, and it would make hiring older people and full time minimum wage range people easier to swallow.
Any llc
Let me tell you boys and girls. searching up " Lump under my jaw ". searching up " Black dots on skin " searching up " Cough that never goes away " Biggest mistake of my life.
I've been traumatized from work
Can you just stick to the definition? Sexual harassment is any behavior (esp by a man) that another person (almost always a woman) finds offensive. Examples: saying hello, discussing the job, sneezing, sharing an elevator, looking in her direction, passing her on the street, performing CPR to save her life being male.
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I love their enthusiasm! 😁
I am not understanding
Thank God I finally asked a Dr for a referral to a neurologist ive been struggling with seizures for years. If I google it's always a brain tumor or brain cancer. I'm terrified of seeing a neurologist because the google Dr already diagnosed me. But I decided to stop being a punk and just see what's really going on. And I I can control it. 😐 I'm pretty nervous though
Good points!
How do I help my dad from not getting bored in a quarantined room?
Thank you for this helpful information. I have always wanted to learn about these things but have not had the time to do so.
Theres also a android version, called “WannaLocker”
June 22 is my bday
Thank you!
What if the biller sends all claims to the clearing house to get the analysis, of whether this claim will get denied/rejected by insurance, therefore to find out the reason for denial prior, should we send all our claims to the clearing house, need suggestions?
N0.1 HARRASEMENT///A RANDOM WORKER WITHIN UR OFFICE ALWAYS ASKING FOR MONEY DESPITE THY R EARNING SO WELL
I almost drowned on my birthday at 6 yrs old 💀
Hi, nice information, can you mention the various techniques to submit the claims (video from 3:20) as you mentioned in the video?
The most dangerous virus is mydoom but i think 2 wala infinite blue.exe krke nahi hota wo wala hona chaiye
The most dangerous virus is mydoom