In order to successfully bill insurance, you need three things:
1) Billing Software
You will need billing software
that allows you to do things like create claims, keep track of claims and patient accounts, generate statements and so on. It’s important to note that medical billing software is not the same thing as accounting software. Accounting software like Quickbooks
allows you to keep track of your books, produce profit and loss statements, and do your taxes. This is important stuff but it’s not what medical billing software does. Similarly, accounting software can’t do what medical billing software does due to the complexity and challenges of how insurance billing works. Years ago, PT practices may have been able to bill on paper, manually but those days are over. The best billing software is usually part of a full package with EMR
and so forth. PT practices should look for systems with built-in billing and avoid separate, “integrated” systems that are always out of sync.
2) Billing Staff/Human Resources
Now that you’ve got your shiny new billing software, you need someone to drive it. You can choose to your own billing in-house with your own billing staff (or just do it yourself if you’re a PT). Some practices don’t have the expertise or time it takes to be bill successfully and so they look to external billing companies or services to help. Both are perfectly viable options and it really just depends on a practice’s staff, resources, and financials.
A clearinghouse is required to transmit e-claims. Think of a clearinghouse as an electronic post office helping take the claims you create in your billing software and delivering them to the various insurance companies. Make sure not to confuse a clearinghouse for a billing service. They aren’t the same thing. A clearinghouse is simply transmitting your claims, they aren’t looking at them in-depth to see what you billed and how you billed it. If you need this kind of support then a external billing service is what you need. Different software vendors handle it in different ways. Clearinghouses do have a cost, whether you pay it directly or it is buried in your billing software fees.