3-tips-to-improve-clean-claims-rate

1. 3 Tips to Improve Clean Claims Rate By some estimates, as many as 20 percent of submitted claims are denied, forcing healthcare institutes to utilize their precious resources on managing the denials or bringing the revenue altogether. That loss can represent anywhere from 3 to 5 percent of revenue. Given the thin margins, many healthcare institutes already struggling with and this additional revenue leakage can make the difference between continued growth and layoffs. To reduce these preventable denials, priority should be given to improve the clean claims rate of the claim before it’s sent out. This will not only help protect revenue that your organization has earned, but will also reduce rework and unnecessary costs associated with managing denials. www.medicalbillersandcoders.com Copyright ©-2021 MBC. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 1

2. 1. Avoid Data Entry Mistakes Mistakes or incomplete information while submitting claims like names, addresses, date of birth, etc. may seem relatively minor, but can cause a claim to be quickly rejected. You can use provider portals to verify patient demographics and insurance information. Every payer offers its own provider portal and this provider portal shares accurate patient demographics information as per the payer database. Most medical billing software provides a scrubbing function in which the claims with demographics and insurance details errors are highlighted before submitting to a clearinghouse. Some software will also proactively flag claims that have the potential to be denied, based on comparisons to a comprehensive database of similarly denied claims. If the software detects a possible wrong code, for example, it will suggest appropriate codes to prevent the claim from being denied and prevent delays in obtaining revenue. 2. Focus on Eligibility and Benefits Verification You would be surprised to know that out of total denials and claim rejections, 75 percent are caused due to problems with patient ineligibility and lack of prior authorization. A depth eligibility and benefits verification report will help you to understand patient insurance coverage, deductible amount, co-payment amount, and need for prior authorizations. With eligibility and benefits verification, you can cross-check patient demographics and insurance information that is provided by the patient. Depending upon the payer’s rules, even the slightest error or smallest piece of missing data may cause a claim to be rejected. As mentioned earlier, eligibility and benefits verification will also help you to identify patient responsibility i.e., deductible and co-payment amount which you can collect at the time of service. www.medicalbillersandcoders.com Copyright ©-2021 MBC. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 2

3. 3. Understand Medical Necessity Some health plans will cover services only if there is a demonstrated medical necessity through clear, concise, and consistent documentation with the most clinically relevant specific diagnosis. Understanding medical necessity and attaching required documentation is the work of a revenue cycle expert. Your revenue cycle expert should be well versed with diagnosis codes, procedures codes, modifiers, documentation, and payer reimbursement policies. This allows for physician clarification prior to service rendering, and the number of denials will be reduced and revenue can be protected. Any healthcare institute’s revenue cycle team would like to have total elimination of denials and claim rejections and 100 percent submitted claim payment. Though practically isn’t possible, the above-mentioned tips will definitely help to improve the clean claims rate in your organization. Maximum clean claims rate can be attained by well-trained revenue cycle experts who are on top of their payer reimbursement policies. If you don’t have such a team, you can always outsource. MedicalBillersandCoders (MBC) can streamline your revenue cycle functions and can improve clean claims rates. Our team of expert medical billers and coders can help to streamline your billing and coding processes like eligibility and benefits verification, prior authorizations, charge entry, claim submissions, payment posting, denial handling, accounts receivable management, medical coding, and provider credentialing. To learn more about our commitment to excellence and performance for medical practices and healthcare at info@medicalbillersandcoders.com / 888-357-3226 providers, contact us www.medicalbillersandcoders.com Copyright ©-2021 MBC. All Rights Reserved Call now 888-357-3226 (Toll Free) info@medicalbillersandcoders.com 3