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Mastering Your Clean Claim Rate: Strategies and Importance

How to Increase Your Clean Claim Rate and Why it Matters

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 tracks how you are managing your revenue cycle is the ‚Äúclean claim rate.‚Äùclean claim is an insurance claim that was successfully processed and reimbursed the first time it was submitted. This means 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. It also shows that claim accuracy is something healthcare providers are paying attention to on the front end. If you submit a clean claim, it spends less time in accounts on the insurer’s end. This results 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 to increase your clean claim rate and ensure that you’re receiving timely and accurate payments.

Strategies to Boost Your Clean Claims Rate:

1) Medical Billing Partner

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 allow your staff to focus on more patient critical tasks and ensure that someone is inspecting claims for errors. Additionally, a medical billing partner will 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. RCM service vendors stay up to date on all medical coding, 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.

Elevating your clean claim rate is pivotal for bolstering revenue cycle efficiency and ensuring timely reimbursements. By implementing strategic partnerships, leveraging advanced technologies, and prioritizing staff education, providers can navigate the complexities of revenue management with confidence and achieve sustainable financial health. Explore additional resources to deepen your understanding of the impact of clean claims on revenue cycles. To learn more about how a clean claim can effect your revenue cycle, click here.

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