Episode Transcript
[00:00:01] Speaker A: Hi everyone. Welcome to this episode of Catch up with Kyrotouch. Thank you for tuning in. I'm your host, Doctor Tammy Howard, and my guest today is Crystal Ewing of Waystar. Waystar offers revenue cycle management solutions and is one of our clearinghouse partners for RCT proclear service. But don't worry, today is not a sales pitch for CT proclear. We asked Crystal to join us as an expert on all things clearinghouses. What are they, how do they work and why? Your chiropractic office may need to use one. Hi Crystal, thanks for joining us today.
[00:00:32] Speaker B: Hi, Tammy.
[00:00:33] Speaker A: Crystal, I'm so excited to have you on the show today. I manage our training team here at Cartouch and one thing I see repeatedly is a lack of understanding about what a clearing house is, especially for our newer docs that are just starting out into practice. Insurance billing is an area that is not really deeply addressed in chiropractic curriculum. So many doctors that started on their own after graduation find themselves scrambling to understand what they need to do to bill insurance. So we have lots of questions for you, but before we get started today, can you tell me a little bit more about yourself and your background with revenue cycle management?
[00:01:08] Speaker B: Sure. Absolutely. And before I begin, I just wanted to say thank you to you and Kyra touch for having me today. I'm really excited about being able to provide some important information about this topic. I've been in the healthcare industry for over 20 years. I started right out of college as a director of revenue cycle for a multispecialty medical practice. I moved on to consulting when healthcare was first starting to use EDI around the early two thousands, helping to set up connections and helping providers choose clearinghouse partners and best practices to understand how to translate those very complicated type of EDI reports into human readable terms and most importantly, how it affects your billing and payments and claims and denials.
[00:02:01] Speaker A: Well, you've been around for a lot of changes, I'm sure, in that timeframe.
[00:02:06] Speaker B: Absolutely, yes. And in addition to my role at Wastar as a director of product management, I'm also chair of the national, the National Clearinghouse association, the cooperative exchange. So the cooperative exchange is committed to promoting and advancing electronic data interchange for the healthcare industry by improving efficiencies and advocacy and education to industry stakeholders and government entities. So what that means is basically whenever the government comes down with a new regulation like ICD ten or the Affordable Care act or, you know, all of these things that really affect our world from a regulatory standpoint, you know, clearinghouses do kind of advocate together to make sure that we are, you know, promoting and helping to bring transparency to those, to those issues. And really, you know, we're the advocate for the provider community as well.
[00:03:05] Speaker A: That's awesome. Well, what a vast knowledge experience you're bringing to this conversation. I appreciate that. I think the big question of the day that a lot of people, a lot of our listeners may not understand is what is a clearinghouse and what did they do?
[00:03:21] Speaker B: Yes, perfect. And I get this a lot. And, you know, really that definition has changed over the last 20 years. And I'll give a little bit of, I'll give a little background into what that means as well. So let's just kind of start with, you know, what it is. A medical claims clearinghouse is basically at its core the middleman between a provider and a payer. So whether you're a physician or a specialist, chiropractic, ob, gyn, ambulance, or you're a hospital, if you are filing a medical claim to a payer, then you probably need a clearinghouse to do that. And what a clearinghouse does is they establish those connections. So if you think about all the insurances that you may work with, you know, it may be five, it may be 500, it may be 5000. All of those, you know, require connections to be able to submit claims electronically. And all of those things require, you know, kind of setups and very complicated connections in addition to, you know, did my files get there? Did they get there successfully? And clearinghouses provide all of those types of values in addition to, you know, traditional just sending claims, a lot of clearing houses have expanded out into other electronic offerings like checking eligibility and claim status and even I prior authorization. So over time, as more and more payers started to come on board with those electronic solutions, clearinghouses were able to provide those pipelines.
[00:05:11] Speaker A: Is that why we hear the term revenue cycle management sometimes kind of used interchangeably with clearinghouse?
[00:05:18] Speaker B: Yes. Yeah. So really I like to describe the difference between a clearinghouse and a revenue cycle management company. I like to use the analogy of the Internet. So, you know, in order to use the Internet, you have to establish a connection and you have to use an Internet service provider. Now, once you establish that connection, you can do a variety of things, right? You can play games, you can stream movies, you can browse for information about anything, you can listen to music. And that's how I kind of separate the difference between a clearinghouse and a revenue cycle management company. So that clearinghouse is that kind of core connectivity. But over time now that we've been able to unlock all of the efficiencies of being able to submit things electronically. We've been able to build workflows and taking those manual processes where you may have had to pick up the phone to go figure out the status of your claim or, you know, calling or using a website to mark a denial. You know, we've been able to build more value added products above and beyond those traditional connections in addition to almost diversifying our portfolio and adding in other things like analytics and even kind of non claims processing type of solutions. So really, revenue cycle management goes far beyond just the traditional, what a lot of people think as edi electronic data interchange. And it really fills the entire revenue cycle from that patient access, checking, eligibility, authorization, filing claims, working denials, down to sending patient statements.
[00:07:21] Speaker A: Yeah, that's interesting. I still see some of our users kind of just scratching the surface of what a clearinghouse can do. And it reminds me as you're talking about all of these other tools that are at people's disposal that are not necessarily always as commonly used as just, you know, sending the electronic claim through, but not necessarily taking advantage of all those other abilities.
So really interesting to kind of think through that a little bit. And I liked your analogy about a clearinghouse being the middleman. That's something that I often use to describe it with our customers as well, that are struggling to understand what it is and why they need it. And every once in a while I'll have an office, a cash practice, and they'll just be kind of wondering, is a clearinghouse apply to them if they're not dealing with any type of insurance at all? Is there any benefit for a cash practice to be using a clearinghouse?
[00:08:17] Speaker B: Actually, there is, and this is kind of where it goes into those value added products. So a lot of, and I'm just going to call them revenue cycle management companies.
You know, a lot of those clearinghouses that have expanded and expanded into those value added products and their RCM capabilities, a lot of them do offer patient payment solutions that allows you to actually set up, you know, a website that looks and feels like your practice so that, you know, patients can pay their bills online, they can pay from a statement, or you can, you know, collect that payment right up front using their software. So they've really, you know, really diversified. So even if you are a cash only practice, there is solutions for a lot of, a lot of those RCM companies.
[00:09:07] Speaker A: Yeah, I never would have really even considered to think about patient payments under that same bucket, but it does make sense that it falls under that same bucket. So interesting. Well, for an office that is looking into and shopping around for a clearinghouse, what's the starting point for somebody that needs to look for a clearinghouse? And what should they be looking for specifically when they're looking for a clearinghouse? Or maybe we should be more accurately depicting it as a revenue cycle management company because it's not just that connection they're looking for, right?
[00:09:41] Speaker B: Absolutely. Yes. So this is my favorite part and really where I love to help providers. So, you know, the first thing that I always tell people is, you know, you really need to understand kind of your current state and really do an assessment.
Kind of think of it as I'm buying a house or I'm moving. What are the specific things that I'm going to need here? And I'd like to say, doing an evaluation of your current processes, are you using payer portals to check eligibility? How efficient are you with working claims? Do you understand how to work claims? Are you struggling with that?
Are you faxing and mailing denials and appeals? How good is your reports? Do you need productivity reporting to understand how your staff is doing?
Do you need benchmarking to understand I'm way above my competitors or I'm way below them. There's all of these different type of features and functionalities that RCM companies will provide. So really my first recommendation is really do your homework. And when you want to make a change like this, you want it to be for the better, right?
You want to increase productivity, you want to increase efficiency and hopefully reduce some of the cost that these manual labor activities and inefficiencies in the administrative process is costing. So I would definitely recommend understand your current state.
Then once you complete that internal assessment, then you're ready to start shopping. You kind of have your list of things and checklists that you can start asking questions. So when you're doing a demo with one of these RCM companies, you'll be able to be intelligent about asking questions and really understanding how they work and what features and functionalities they have. And most importantly, they should be asking you those questions, too. So the first thing that I do when I'm, you know, I'm working with a provider is I want to know, you know, kind of what they're doing today, what their concerns are, you know, what's working and what's not working so that we can tailor that and make sure that we do have solutions that was going to solve those very important problems to them.
[00:12:16] Speaker A: That's an interesting perspective. Start with almost like a needs analysis, right. And go from there to understand that you're looking at the right solution. So I like that. Is there a benefit of working with a partner that integrates into the software versus one that does not?
[00:12:33] Speaker B: So that's a great question because it really depends on what you want the workflow to be. I've seen some providers that just wants to be able to work in their source system and that's important to them.
So, you know, if that's important to you, you know, those integration questions, do you integrate, you know, with my software is extremely important because that's how you want to work and you want to work with a vendor that, you know, is integrated with your source system. You know, there's, and there's other providers that say, well, I don't care, I don't need that functionality. I'm okay, you know, working outside of, of that source system. And then there's what I would call the hybrid model. So there is some certain situations where, you know, you want to work in your core system, but they may want to work with their RCM vendor for some things that they may not be able to get work. Queuing is a great thing, like workflows and work centers.
And I want to be able to, you know, sort certain claims and send a, you know, some of them to this, to this staff and some of them to that. And, you know, there's, it really depends on the features and the workflow that, you know, that that provider is looking for.
[00:13:49] Speaker A: Any final thoughts or parting words of wisdom for our audience today?
[00:13:54] Speaker B: Well, I always like to part with this in addition to, you know, kind of that real technical understanding, features and functionalities. Don't overlook your support because this is one thing, you know, when providers are looking for a clearinghouse partner, they tend to focus on the technical impact that it will have to their organization, such as those metrics and clean claim rates and things like that.
But one thing that gets ignored a lot is what level of customer service are you going to need, you know, in addition to that, prompt technical support? A good clearinghouse partner, they're going to be there for you when there's an issue, they'll be proactive advocates on your behalf. For example, rather than telling you to go call a payer and go figure out why your claim has been denied, a good clearinghouse partner will work with you. They'll make that call for you. They'll help to ensure that the matter is settled correctly, and they'll really be there to support you through the entire journey. So those are really important questions. In addition to, you know, those features and functionality, really understand what their level of support is going to be.
[00:15:06] Speaker A: Well, thank you so much again, crystal, for sharing your knowledge on this topic with us. And thank you to our listeners for tuning in to catch up with power touch. Find more episodes of catch up with Caretouch on Spotify, iTunes, and chirotouch.com podcast. Again, I'm your host, Dr. Tammy Howard, and I wish everyone listening a well adjusted day.
