What Are Best Ways To Boost Clean Claim RatioMed Miles LLC
A clean claim is a claim filed without any errors or other issues, including incomplete documentation that delays timely payment. There are several required elements for a clean claim, and medical bills are rejected if the elements are incomplete, illegible, or inaccurate. A clean claim ratio encounters all of the following requirements:
- Sufficiently identifies the patient and health plan participant.
- Lists date and place of service.
- Eligible for covered services for an eligible person.
- If necessary, they will document the medical necessity and appropriateness of the service provided.
- If prior authorization is required for certain patient services, it contains information sufficient to demonstrate that prior authorization has been obtained.
What is the Clean Claim Ratio?
If the provider submits a claim that does not contain errors, defects, incomplete documentation, or unusual special circumstances, this is a clean claim. A clean claim provides all the information needed to process a claim and enables timely payments.
Why is Clean Claim Important?
As mentioned above, clean claims have ensured that organisations have covered all their bases and checked that they are flawless, including all necessary and detailed documentation. According to a survey by the Healthcare Information and Management Systems Society, 76% of healthcare executives say that claims denial is the biggest challenge they face. One study found that 9% of hospital charges are initially denied—and a lack of clean claim ratio leads to those denials. Many of these claims are easily fixable and could have been avoided. If the claim has errors or missing information, the insurer will reject it. This hurts both the patient and the provider for financial reasons.
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Ways to Boost Clean Claim Ratio
Keep Patient Information Updated:
From contact information to insurance carriers and more, there is a lot of patient information that can change. Since inaccurate patient information is the leading cause of denied claims, patients must confirm or update their current information before receiving services. To help verify patient information in advance, use accurate documentation to avoid delays and ensure patients update their forms at each visit or earlier with automated reminders.
Incorrect coding, whether intentional or unintentional, will result in rejection. Inadvertent miscoding means that your coder either entered old codes, entered them incorrectly, or a single character is missing from the code. Deliberately wrong coding means misuse of modifiers. To earn more, providers sometimes enter incorrect modifiers. Multiple miscoded claims can lead to fraud or abuse. Outsourcing a medical billing company can give you access to expert coders to help increase your net clean claim ratio.
Focus on Timelines:
Submitting accurate claims within each payer’s expected filing period is a major key to the skyrocketing clean claim ratio. But before filing claims, you need to think about timeliness. Finding and resolving any patient coverage issues requires a concerted effort up front. For all payers, try to verify patient eligibility at least two days before the date of service. For important procedures, seek authorization within five days of the date of delivery.
Detailed Medical Documentation:
Information to verify – medical history, need for service documentation, procedure documentation, patient medication history. If required by carriers, medical records serve as supplemental records for claims processing.
The above checklist can be modified and adapted to suit your centre’s requirements. Slowly build a process to make these key elements part of your centre’s operational flow. Clean claim ratio lead to faster reimbursement and an organised workflow.
Mention Correct Modifier Usage:
Information to verify – the use of the used modifier, connecting the modifier to the correct procedure. Create customised National Correct Coding Initiative (NCCI) editing guidelines that decide modifier use.
Undertake Quality Checks Before Submission:
Information to Verify – Review each request for demographic, coding, or submission errors before submission.
Education and Training:
All employees involved in any part of the revenue management cycle should be educated on the importance of a high net claim, common mistakes that occur, and plans to improve it. Your medical billing partner or software vendor should offer you training during and after implementation. While your partners are doing a great job of improving your net claims rate, the more educated your staff is on proper billing practices and how to properly use medical billing software, the more improvement you’ll see.
Enhance Quality Control:
Eliminating claims errors is critical to the financial health of your practice. However, the billing and collection process does not stop after the claim is approved. Using generally accepted accounting practices to book and record payments helps healthcare providers keep a close eye on cash flow. You can improve account balance accuracy by creating a deposit log for each receipt that is sent to the billing team. The log must contain all the information needed to ensure correct posting and also to allow the controller to easily confirm the correct payment amounts posted to the correct accounts.
The protocol should contain the following basic data:
- Patient name
- Account number
- Check/Cash Number
- Amount owed
- Date of service or reference number.
Be Aware of Insurance Claim Filing Deadlines:
Applications usually require submission within a short period. Claims submitted outside of this window are more likely to be denied. The best way to ensure your practice has a near-perfect clean claim ratio is to pay attention to claim deadlines. If there are patient coverage issues before the date of service, resolve them to avoid late claims. The ideal time for authorization is three to five days before the service.
Despite the difficulties presented by high-deductible plans, practices can operate successfully in the new environment, and they are wise to try. The trend of increased patient responsibility is not going away anytime soon. To effectively adapt their practice management techniques, physicians should know what to expect from new plans and how to proactively mitigate the impacts to streamline collections and increase clean claim ratio.
For many healthcare practices, the best option may be to partner with an experienced medical billing service to help them update their processes and free up valuable time and resources that can be devoted to providing better care. NCG Medical has four decades of experience working with health authorities across a range of practice areas.