The question came to me the other day: How does a clearinghouse fit into the broader scope of healthcare reform initiatives designed to reward quality care improvement? I think the answer has to do with practice productivity. While there are a number of ways to go about participating in incentive-based reform initiatives, practice productivity will be a key element in their success.
Think of all the things you must do at work every day. Everything takes time. So, let’s say your practice has decided to participate in the Physician Quality Reporting Initiative (PQRI). That single decision requires you to: read and understand the regulations; choose which PQRI measures your providers will track; and determine the most efficient methods for reporting, tracking, and getting reimbursed for those measures. It’s not something you can do in 20 minutes.
Setting up and tracking just one quality improvement initiative entails a detailed analytic and tracking process. With most practice staff already operating at full capacity, clearinghouses and other revenue cycle management (RCM) solutions can provide the efficiencies necessary to free your time for PQRI, e-prescribing, and all of the other incentive programs out there.
After all, if you have to continue spending much time tracking down and filing claims, the primary reason for using a clearinghouse is defeated. On the other hand, if office staff no longer need to re-work rejections, for instance, they can concentrate instead on identifying and contacting patients eligible for the kinds of preventive services that form the cornerstone of most health reform incentive programs.
While participation in various quality improvement initiatives may not seem crucial now, it soon may become so. The writing is on the wall; eventually, these programs will not be optional. It’s time to question your clearinghouse if you are not receiving the types of efficiencies that liberate your time for productive, care-enhancing processes.