As a healthcare provider, you are most likely familiar with revenue cycle management. Guaranteeing that your practice receives payment in a timely manner from both private and government insurance payers is crucial for your operating margins.
A key revenue cycle metric that tells you how you are doing with managing your revenue cycle is the “clean claim rate.” A clean claim is an insurance claim that was successfully processed and reimbursed the first time it was submitted with no errors, rejection, or need for manual input of additional information. Having a high clean claim rate indicates to insurance providers that the data you are collecting is high quality and that claim accuracy is something healthcare providers are paying attention to on the front end. If you submit a clean claim, it means the claim spends less time in accounts receivable on the insurer's end, resulting in faster payments back to you.
Industry best practice for clean claim rate is 90% or above, which can be a difficult mark to hit. However, there are many ways that you can work to increase your clean claim rate and ensure that you’re receiving timely and accurate payments.
Four Big Ways to Increase Your Clean Claims Rate:
1) Medical Billing Partner
Since the clean claim rate is such a significant metric of the overall efficacy of your revenue cycle management, partnering with a vendor of RCM services to focus solely on improving the clean claim rate is a great place to begin. This will free your staff up to focus on more patient critical tasks and ensure that someone is inspecting claims for errors before they are submitted. Additionally, a medical billing partner with years of experience would take the necessary steps to ensure your clean claims rate stays higher than 90%.
2) Claim Scrubbing
A quality vendor of RCM services that are dedicated to increasing your clean claim rate goes above and beyond to prevent a claim from being submitted if it will not be approved. A checkpoint system that your medical billing partner should offer is claims scrubbing. It is critical to continually stay on top of payer regulations so that claims are not rejected for not meeting those requirements. An RCM services vendor has the resources to stay up to date on all medical coding changes, ensuring your claims are coded correctly before submission. Denials commonly occur when the claim is coded incorrectly, or it was submitted too late. Claims scrubbing ensures that errors in coding are being identified immediately and quickly resolved prior to submission. By partnering with a medical coding expert, providers can take peace of mind that their clean claim rate will rise.
3) Medical Billing Software
There are many different vendors of medical billing software available to help with claims submission. The other important method to maintaining a high clean claim rate is to have a quality medical billing software implemented at your practice. Many programs have billing analytics tools that can help with prior authorizations and identifying errors in codes before they are submitted. This helps providers to structure a sound revenue cycle compliant with industry standards. Quality vendors of medical billing software will include clearinghouse edits, and claim scrubbing features built-in so you can identify and correct errors before they are submitted to the payer for reimbursement.
4) Education and Training
All staff that are involved in any part of the revenue management cycle should be educated on the significance of a high clean claim, common errors that take place, and the plans to improve it. Your medical billing partner or software vendor should offer training both throughout and post implementation. Even if your partners are doing great work to improve your clean claim rate, the more educated your staff is on sound billing practices and how to properly use medical billing software, the more improvement you will see.
There are many additional resources out there to help providers increase their clean claim rate. To learn more about how a clean claim can effect your revenue cycle, click here.
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