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Lessons Learned from a Successful Clearinghouse Implementation

The organization I work with, Pocono Health System is made up of several components, including the Pocono Medical Center, the Pocono Health Foundation, and Pocono Healthcare Management (PHM). As manager of PHM—the management services organization that supports Pocono’s 82 providers—I recently had the opportunity to help guide our implementation of a new clearinghouse, which was done to help improve our revenue cycle.

When PHM opened its doors in 2003, it chose to use a practice management system that came with its own clearinghouse solution. While that might sound ideal from an integration standpoint, the software itself was not proactive and client support was practically non-existent. In fact, as often as not, we informed the clearinghouse about critical changes to claims edits! Most of our suggestions fell on deaf ears.

In a way, the first lesson PHM learned from its new clearinghouse implementation came before we even selected a different system. Our experience with our original system taught us to place “client support” high on the list of search criteria. We didn’t want our financial viability to be at the mercy of a non-supportive vendor again, so we chose a solution partly on the strength of its guarantee that every call will be answered by live support staff. (I have to admit I was skeptical about that guarantee, but the clearinghouse has lived up to its promise.)

Here are a few more “lessons learned” that you might find helpful:

  • Stagger go-live dates if implementing two solutions. PHM chose to install a new electronic health record (EHR) and clearinghouse at the same time. In such instances, it’s just as important to test with the clearinghouse to ensure manual billing functionality as it is to test automated workflows. Why manual? Because if you should encounter problems at the EHR level, you’ll be able to take claims on paper and keep the revenue cycle flowing while working with the EHR.
  • Choose a clearinghouse that promises to stay on top of your account. We now have a specific account manager who tracks trends and brings perspective to our financial picture. Our clearinghouse tells us how our numbers look, rather than us alerting our clearinghouse to potential problems.
  • Make sure your systems generate accurate reports—even in “test mode.” If you can’t extract data properly, you’ll have problems with everything from quality care initiatives to performance reviews—let alone gaining an accurate picture of your bottom line! Unfortunately, during implementation of former systems, we knew while still in “test mode” that some reports weren’t accurate. We accepted the excuse that “test mode” was to blame—then spent about a year trying to generate accurate reports. Now, I consider it a deal-breaker if numbers don’t match in test mode; a vendor isn’t living up to its contract if it can’t do what it promises to do.
  • Get actual billers involved in the set-up process. Although PHM involved billing managers in the clearinghouse implementation, I would recommend including billing staff as well—those who perform the various billing functions day-to-day. In the long run, I believe it could have saved a bit of training time on the back end.

In the end, I think a successful implementation comes down to good communication and good customer service. It requires a willingness on the part of all involved to work together to overcome the inevitable challenges.

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