In the realm of DME (Durable Medical Equipment) billing and O&P (Orthotics and Prosthetics) billing, the role of clearing houses is a pivotal link between providers and insurance payers. Clearing houses, such as Waystar, are key players in smoothing the path of revenue cycle management. Let’s dive into the role of clearing houses, the services they offer, and how they integrate with EMRs. 

What is the Role of Clearing Houses in DME Billing and O&P Billing?  

In DME and O&P billing, clearing houses operate as a third party between providers and insurance payers. The clearing house’s role is to scrub claims on the front end of submitting a claim to a payer and to format claims correctly before submission. Overall, clearing houses play a critical role in optimizing the revenue cycle management process for providers, helping them streamline billing operations, reduce administrative burdens, and improve financial performance. 

Clearing Houses in DME and O&P 

Waystar and Change Healthcare are the two most common choices of clearing houses for providers in DME and O&P. They are both specialized in this industry and provide services to help businesses get claims paid. Generally, the services offered by clearing houses include the following:  

Claims Submission: This includes receiving claims from healthcare providers and processing them electronically before transmitting them to payers, verifying that the claims are complete and accurate according to industry standards and payer requirements. 

Claims Scrubbing: Clearing houses review claims for errors or inconsistencies and scrub them to ensure compliance with coding regulations (such as HCPCS codes). They identify and correct errors before submitting claims to payers, reducing the likelihood of claim rejections or denials and reducing the time claims spend pending approval. 

Eligibility Verification: Clearing houses will electronically verify patients' insurance coverage and eligibility for services before claims are submitted. This helps healthcare providers determine patients' insurance status and coverage details, reducing the risk of claim denials due to eligibility issues. 

Claim Reconciliation: This includes the facilitation of claim reconciliation between healthcare providers and payers to ensure accurate and timely reimbursement. They track the status of submitted claims, identify unpaid or underpaid claims, and follow up with payers to resolve any discrepancies. 

Reporting and Analytics: Clearing houses often provide reporting and analytics tools to help healthcare providers track and analyze their billing and reimbursement activities. This includes generating reports on claim submission, payment status, denial rates, and other key performance indicators (KPIs) to support revenue cycle management. 

Nymbl Systems’ Partnership with Waystar 

As the most integrated electronic medical record (EMR) system partner with Waystar, Nymbl Systems has been able to pass on many benefits of using Waystar as a clearing house within the Nymbl platform. Nymbl’s integration with Waystar includes:  

• Integrated claims sending functionality. 
• The ability to receive remits back to the software using patient statements.  
• Viewing claim status responses in Nymbl. 
• Pulling in credit card payments made by patients through Waystar. 
• Real-time eligibility checks.  

This enables providers to navigate multiple pieces of their workflows all in a single software system, saving hours of time in the long run. 

Not currently a Waystar customer? No problem. While a majority of the customers that Nymbl serves were already using Waystar before they began using Nymbl Systems, it’s a streamlined process to connect the clearing house to Nymbl for new Waystar users. After getting set up in Nymbl and Waystar, all that’s needed to connect your revenue cycle data from Waystar with Nymbl Systems is a login username and password. And voila! Your systems are connected and accessible from the same platform. 

Through rigorous claims scrubbing, eligibility verification, and proactive reconciliation, these clearing houses pave the way for seamless revenue cycle management. Nymbl Systems' partnership with Waystar is a great example of the potential synergy between innovative EMR systems and cutting-edge clearing house services, promising providers streamlined workflows and enhanced efficiency. As the healthcare landscape continues to evolve, the role of clearing houses remains steadfast, anchoring providers to financial viability and operational excellence.