ZhenMD

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Finishing your note and dropping in the codes doesn’t actually send the claim to the insurance company. At least not directly. Most claims stop at a billing clearinghouse first. It’s one of those parts of healthcare that almost nobody in clinic thinks about, until it breaks. Here’s why it exists. There are hundreds of payers, and every one of them wants claims formatted a little differently. The clearinghouse sits in the middle and handles that translation. Think switchboard operator, or if you’re more of a tech person, an API integrator. It also scrubs your claims. Missing member ID, invalid code, fields that don’t match up, it catches those and kicks the claim back to you before it ever reaches the payer. The whole point is getting a “clean claim” through so you’re not eating automatic denials over typos. Once the payer processes it, your practice gets an ERA, or Electronic Remittance Advice. That shows what got paid, adjusted, or denied. It’s basically the practice’s version of an EOB. Quick additional note on rejections by the clearinghouse vs denial by the payer: those up-front rejections from the clearinghouse don’t come back on the ERA. They show up in separate acknowledgment reports (you might hear them called a 999 or 277CA to let you know of rejections due to error, which are different than denials after payor processing). The ERA is only for claims the payer actually processed. So why should you care? In 2024, Change Healthcare, one of the biggest clearinghouses in the country, got hit with ransomware. Claims just stopped moving. Practices went weeks without getting paid, and some couldn’t make payroll. Some even closed. Before that, most of us had never even heard the name. Now you know where it fits. Let me know if the Change Healthcare attack affected you and your practice in the comments! And let me know what other business in healthcare topics you wanna learn about! #Medicine #Healthcare #Insurance #Middlemen #BusinessofMedicine

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And then for some ungodly reason the year after, it becomes the other way around for the same exact patient. #Insurance #Medicine #Healthcare #Asthma #Pediatrics

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Cigarettes are a definite no — Did you know as of 2023, 1.66 million deaths globally can still be attributed to secondhand smoke exposure? In children, exposure is causally linked to increased respiratory illnesses including pneumonia, bronchiolitis, and asthma exacerbations. Fridge cigarettes, more formally known as Diet Coke, are also frowned upon because it’s soda and we gotta model good behaviors for our kiddos! While there is no substantial harm data from artificial sweeteners they still shouldn’t be an encouraged daily beverage. While in kids who drink a lot of sugar-sweetened beverages, it could be seen as a beneficial step to switch, for those who don’t drink soda regularly, it shouldn’t be considered “healthy” or a substitute for water and milk to hydrate. So I found the next best thing. And I get to give extra cards to the kids 🤙🏼 @Pokémon/ポケモン【公式】