DME billing is undeniably complex. With numerous steps between the initial order and final reimbursement, it’s easy for claim denials to pile up, especially without the right technology in place. Maybe a patient’s contact info was entered incorrectly, or an outdated HCPCS code was used. Either way, denials lead to delays, which ultimately impact your cash flow.
Claims clearinghouses ensure that claims are clean before they’re submitted to insurance agencies and other payers. Investing in a platform with a direct connection to clearinghouses can reduce rework, improve turnaround times, and support stronger cash flow.
Why Clearinghouses Matter
Clearinghouses, sometimes called medical intermediaries, are organizations that facilitate the exchange of healthcare data between providers and payers (e.g., insurance companies, Medicare, Medicaid, etc.).
While there are several types of clearinghouses, most DME providers work with medical billing clearinghouses, which are often referred to as electronic claims clearinghouses or ERA (electronic remittance advice) systems.
Clearinghouses have several responsibilities, including:
- Claim validation: Scrubbing claims for common errors before submission
- Claim formatting: Converting data into the standardized EDI 837P format required for DME billing
- Claim submission: Routing clean, compliant claims to payers for processing
- Claim posting: Routing 835 transactions and associated metadata
Working with a clearinghouse adds a critical layer of protection against denials and payment delays.
Related: What Does a Clearinghouse Do During Claims Submission?
The Power of a Billing Platform-Clearinghouse Integration
Your software plays a critical role in how efficiently you submit, track, and manage claims. A DME billing platform with direct clearinghouse integration can significantly reduce the administrative burden on staff while improving billing accuracy and speed.
When evaluating DME billing platforms, look for these features:
- Real-time claim scrubbing: Does the system deliver instant alerts for missing or inaccurate data?
- Individual claim transmission: Will it avoid the delays that come with batch processing?
- Faster eligibility checks: Does it offer automated access to payer databases for swift verifications?
- Claims tracking dashboards: Is there clear, centralized visibility into reimbursement statuses and follow-up needs?
By investing in a platform with these capabilities, you can significantly reduce denials and accelerate cash flow without compromising compliance.
Now Is the Time to Invest in an Integrated Solution
HME News reports that rising labor costs are straining DME operations, causing delays, errors, and higher administrative burdens in key billing functions like claims management, prior authorization, and denial management. With staffing shortages and strained budgets across the industry, the efficiency of billing workflows is under scrutiny.
Manual processes and complicated tech stacks make it harder to keep up with claims. In the worst-case scenario, they lead to costly delays and denials. Choosing a platform that streamlines these workflows is more than a convenience—it’s a necessity.
TrueSight: The Only DME Tool With a Real-Time Clearinghouse Connection
With decades of experience in DME billing, Medbill understands the operational challenges providers face—from staffing shortages to rising denial rates. That’s why the team developed TrueSight, the only modern DME billing platform with a direct clearinghouse connection.
This capability, along with Medbill’s broader support services—like billing outsourcing, document review, and AR management—offers providers a practical path to more efficient operations.
If you’re evaluating new software or looking for ways to ease the burden on your team, let’s talk about how Medbill can support your next steps.
Contact TrueSight for your FREE DEMO today.