Faster payments and ease of claims processing are just two goals for physician practices around the country, and many have found that a clearinghouse service is one way to achieve this.
Regulatory changes and industry innovations have helped propel the ambulatory clearinghouse market of late. One such vendor to benefit from this is Navicure, the Duluth, Ga.-based provider of Web-based accounts receivable management services for physician practices, which launched version 4.0 of its flagship product this past July.
“We noticed a huge difference from what we were doing before,” said Michael Delac, practice manager for Macon Medical Group, PC of Macon, Ga. “Navicure 4.0 gave us a way to understand the rejection analysis and we are able to look at a dollar impact on a practice.”
Using a clearinghouse product also allows Macon to monitor and make immediate changes in staff to increase productivity and revenue.
“Within five months, Navicure has helped us decrease average days in A/R from a horrific 47 days to 31 days,” said Delac.
The software is useful for payment analysis, according to Denise Junkin, a project manager who spearheaded the release of Navicure 4.0. It’s targeted at managers, and the reports are exported to Excel and broken down by facility, payer and provider, allowing users to see where the money is coming in, where the money should be coming from and where the denials are coming from, among other things.
According to Junkin, users like the benchmarking tool included in the product – and they want more of it. The Web-based platform is designed to improve practice staff efficiency and productivity.
“The online portal allows for online claims editing where users can view those claims with issues, identify what the problems are, make the changes online and re-submit them, scrubbed, cleaned edited and good to go,” said Mark Wagner, senior research manager for ambulatory space/research at KLAS.
The work list feature has proved useful and representatives use it on a daily basis at Annapolis, MD-based Orthopaedic and Sports Medicine Center, according to Jennifer McLean, operations manager for the practice. A lot of filters are available to sort claims such as front desk items and demographic issues. The solution also allows the practice to see claim counts or claim dollars for analysis.
Clearinghouse services can be paid on a per-claim basis or per provider per month, the latter of which, Wagner said, is becoming more popular with doctors. And many practice management (PM) vendors allow the provider to select a clearinghouse from a list of preferred vendors.
Navicure, Gateway EDI of St. Louis and Louisville, Ky.-based ZirMed, three of the nine clearinghouses rated by KLAS, use direct relationships with the provider, cutting out the middleman. This cuts days out of the claims process, said Junkin.