The profitability of physician practices is being squeezed by declining payer reimbursement rates and increasing operating costs. There is also a growing trend towards enhanced patient responsibility both for self-pay and insured patients. This has a direct impact on physician practices which now run a risk of increasing patient account receivable (A/R) balances.
Proactive revenue cycle management processes are key to ensure full and timely reimbursement from payers and minimizing the financial risk due to patient A/R exposure. Even though clearinghouses had a limited function earlier, the scope of functionality delivered by a good clearinghouse has increased significantly and encompasses entire revenue cycle stretching from insurance verification, claims submission, remittance and all the way to appeals and settlement.