Billing accurately and promptly is one of the vital signs of a healthy practice. Desné Marston, with nearly 30 years of practice management experience, explains how Healthcode’s Clearing Service powers this critical business process.
You could be one of the most skilled and respected doctors in your specialty, but if your bills are error-strewn, do not meet the private medical insurer’s rules or are submitted long after the patient has been discharged, you risk cash flow problems that could jeopardise the long-term survival of your practice.
If your independent practice is to prosper, billing is one area that you need to get right, so it is reassuring to know that Healthcode’s clearing technology enables you to send bills quickly, easily and securely to their intended recipient.
How did we get here?
Billing insurance firms was once a purely paper exercise. Practices drew up an invoice that needed to include all the information required by that insurer in the correct format, such as the patient address, policy number, date of treatment and procedure code. These rules varied.
The invoice was usually printed and posted, which was costly and time-consuming. Plus, it was impossible to be sure that it had been received and when it might be paid.
Practices were no wiser about problems, until they were notified of a query or asked to resubmit the invoice, causing unwelcome delays.
The whole process was inefficient, unsecure and burdensome for billing staff, while from a financial perspective, it was virtually impossible to make accurate cash forecasts.
Nor was paper invoicing popular with the insurers themselves. After all, each practice might only send a few invoices per week but insurers would be faced with thousands every day.
Even if only a fraction contained errors, it would be many hours administrative time before issues could be resolved and the payment finally made.
Insurers turned to Healthcode to develop a Clearing Service for medical bills that would provide an accurate, efficient, secure and cost-effective alternative to traditional paper invoicing.
We launched the Clearing Service in 2002 and before the pandemic struck, we were processing more than 7m invoices each year for practitioners and hospitals, equating to more than £3.3bn of activity.
What is a clearing service?
Electronic clearing houses are common in countries like the US, where insured healthcare is the norm. They are essentially online hubs which pre-screen claims for medical practices and transmit them securely to private medical insurers. They also enable practices to submit all their invoices from a single platform.
As you can see from the diagram at the top of the page, Healthcode’s Clearing Service works along exactly the same lines:
A practice generates an invoice or batch of invoices using Healthcode or third-party billing software.
It uploads the invoice – or the batch – for clearing and validation by our Clearing Service.
The Clearing Service automatically checks that each invoice complies with the relevant insurer’s own validation rules, including:
- The invoice number and date;
- Provider details, name, provider number or professional number, specialty and billing address;
- Patient’s full name, birth date, address, insurance company/paying organisation, policy number, diagnosis and description where applicable, lead practitioner;
- Treatment type, date, service delivered, procedure code, description and, where applicable, fee.
The Clearing Service sends validated invoices to the relevant insurer for processing and payment. It flags invoices with errors and anomalies to the practice so they can be corrected and resubmitted.
The practice can see the status of each invoice.
The insurer pays the practice and sends remittance advice. Practices can also use the Clearing Service to view and print remittances where the insurer has made this information available.
From paper bills and payments by cash or cheque to e-commerce and contactless payments, financial transactions have been part of a digital revolution and the pandemic has accelerated that process.
However, it simply would not be possible without technology which enables transactions to be processed seamlessly, efficiently and in a fraction of the time of old-school paper-driven systems. We are proud to have made this a reality for independent practitioners since 2002.
Desné Marston (right) is product marketing manager at Healthcode