A clean claim is one that’s submitted without any mistakes or problems that could stop payment. When the Clean Claim Rate goes up, it means the info in the electronic health record is really good. This shows that claim processes are very accurate.
No matter how we achieve a high CCR, whether by being more accurate at the start or using custom claim routines, the result is quicker payments, less manual work, and lower costs.
If you want to know more about what a clean claim is in medical billing and why it’s important, keep reading the blog.
What’s the Impact of Clean Claims on Healthcare?
Understanding what clean claims are is crucial. Let’s see how they affect healthcare practices.
Your clean claims rate directly affects how much money your medical practice makes. If your billing and coding aren’t done well, claims might get delayed or denied. This can hurt your practice. That’s why, healthcare providers who choose to work with the medical billing agency generate more revenue and have ample time for patient care.
Rejected claims often need to be fixed and resubmitted. Sometimes, these errors aren’t fixed properly. Wrongly submitted claims can even cause legal problems. If your practice sends out too many poorly done claims, it could look like you’re committing fraud.
Why Are Clean Claims Important?
Knowing what clean claims are is one thing, but it’s also important to understand why they matter. If your claims aren’t clean, they can mess up your practice’s revenue and cash flow.
Many medical practices often have a lot of their claims denied. This happens when claims go through a clearinghouse or insurer. Using coding rules and claim scrubbing can help reduce errors and denials.
Here are some common errors that lead to denials:
- Wrong CPT code for the service date
- Missing patient treatment code
- Errors in the treatment code
- Patient not eligible for service on that date
- Incorrect member ID
- Make sure to check all billable codes when there are new coding changes. Also, staying updated on rules and payer regulations can help with proper coding and less delays in getting paid.
If a claim is clean when it leaves your practice, it can speed up the time it takes to get paid by the insurer.
Follow these easy steps to ensure your medical claims are processed smoothly
Verify all billable codes to reduce errors when new CPT and ICD codes are introduced. Also, stay informed about changes to billing principles and payer rules to avoid delays in patient payments.
Make sure patient information is accurate. Errors in patient data can lead to claim rejections. Keep patient records up to date in your electronic health record (EHR) and review them regularly.
Stay updated on medical coding regulations. Regulations change of;ten, and it can be hard to keep track, especially if you have office staff handling billing. Consider outsourcing medical billing to experts who specialise in staying current with code changes. They can help ensure your claims are always accurate and up to date.
Want to Improve Your Clean Claim Ratio?
Understanding clean claims in medical billing is one thing, but boosting your clean claim ratio is another. If you’re in the medical field, you’re likely familiar with revenue cycle management (RCM). It’s crucial for your practice’s finances to make sure you get paid promptly from insurance companies. Your clean claim ratio is a key indicator of how well you handle your cash flow.
Claim Scrubbing
One way is through claim scrubbing. This is a system provided by reliable RCM service providers to catch errors before claims are submitted. Staying updated on payer requirements is essential to avoid claim rejections. RCM service providers keep up with coding standards to ensure your claims are coded correctly before submission. By catching coding errors early, you can avoid claim denials and save money.
Partner with expert medical billing provider
Another strategy is to work with a medical billing partner. Collaborating with an RCM service vendor can help you focus more on increasing your clean claim rate. This allows your staff to concentrate on patient care while ensuring claims are carefully monitored. A medical billing partner can also take proactive steps to maintain a clean claim rate above 95%.
Conclusion
What does “clean claim” mean in medical billing? Submitting medical billing claims can be tough. But if done right, it’s smooth sailing. Clean claims mean less denial hassle and faster payment. They boost revenue and keep cash flow healthy. Every denied claim adds weight to your accounts and cuts into your practice’s earnings. Denials cost time and money, so it’s best to avoid them.
