How can you ensure that your claims are sent out in a clean state? The answer to this issue is getting more difficult to articulate in light of the current state of the healthcare system. Providers are hitting their heads against the wall as a result of the requirement for extremely accurate claims and flawless clinical documentation.

Almost certainly, as a healthcare practitioner, you are familiar with revenue cycle management. It is vital for your operating margins that your practice receives prompt payment from both commercial and government insurance payers. It also demonstrates that healthcare professionals pay attention to claim accuracy at the outset. If you submit a clean claim, the insurance will spend less time processing it. This expedites your money back to you. 

Why are denials of claims increasing?

69% of healthcare industry leaders in USA reported that denials rose in their firms in 2021.

There are four primary internal factors that frequently contribute to an increase in denial rates.

• Accumulating a backlog of rejections
• Staff churn rate
• Insufficient resources
• Need for advancements in technology

How You Can Improve Clean Claim Rate?

The industry standard for a clean claim rate is at least 90%, which can be challenging to achieve. However, there are numerous strategies to improve your clean claims rate and ensure that you receive reimbursements on schedule and in full.

The following are 10 critical tactics that can assist reduce the number of claims that are denied and enhance the financial outcomes for your firm.

Review Denials 

It is important to remember that denials are not a sign of failure but rather a golden opportunity to get valuable insight that can be used to avoid making the same mistakes in the future. After that, it is important to keep an eye on claims that have been denied to see whether or not they can be reinstated.

Make it a priority to keep a record of all the denied claims that your practice experiences and to report them. There is a significant amount of room for improvement in your clean claim rate if you quantify the many kinds of denials you get and gain an understanding of when, why, and how these denials occur.

Identify Common Denials

If healthcare practitioner knows the source of denials, they can more easily standardize and streamline their responses to specific denials, as well as create templates for the most effective responses. You have the ability to investigate what the common causes are for such persistent problems, whether it be erroneous insurance claims, insufficient medical paperwork, or other types of mistakes. Your team will be able to boost their efficiency when it comes to submitting claims the first time around if they first identify common denials, determine which payers seem to decline claims for which reasons and remain current on what payers require.

New Denials Early 

Increasing the possibility that new denials can be turned around early on in the process requires identifying new denials. Maintaining awareness of newly issued denials is an important step in ensuring you can still receive prompt payment from the payer. Having an awareness and attentiveness of denials is beneficial to the overall financial health of your practice. Contacting payers who have denied claims as soon as feasible help provide clarity about what is needed by that payer and minimize the number of days accounts receivable are overdue. With the help of this explanation, your team may be able to resubmit an accurate claim. Maintain a level of awareness of the criteria that payers use to evaluate appeals.

Document Patient Information

Your coding team is able to more accurately assign codes when they have access to accurate documentation, which results in better and faster reimbursements. Make sure that you include more in-depth details not just on the diagnosis but also on the patient’s previous medical history as well. Also, if an outside group is providing the diagnosis, check to be that they have the most recent CPT and HCPCS codes. Claims that are denied are more likely to occur when using outdated codes.

Monitor Your Payers’ Policies

Acquaint yourself with the modifications that can be used. For a specific operation, you need to determine whether or not you should apply a -50 modifier or –RT and LT instead. Learn and comprehend the medical procedures that will be covered by your payer as well as those that will not be covered by them. Determine whether or not the payer will pay for medical screening, and find out whether or not they will withhold payments in the event that several procedures are performed. The ability to anticipate changes in payer regulations can have a significant impact on the amount of reimbursement you receive.

At Aplus RCM, our medical billing teams have access to the most recent updates and websites provided by payers in their respective industries. They also create robust business ties with the payers, which enables them to assist the key players in being well-informed of the most recent updates and modifications to the process.

Remember Insurance Claim Deadlines

The submission of claims is typically required to be done within a limited time range. And the submission of a claim at any time outside of that window results in an increase in the number of claims that are refused.

Paying attention to claim deadlines is one of the best ways to achieve a near-perfect clean claim ratio for your practice. If you want to achieve this goal, one of the best ways to do so is to have a goal of having a near-perfect clean claim ratio for your practice. If there are any problems associated with patient coverage prior to the date of service, you should resolve them so that the claim is not submitted late. The goal should be to receive authorization between three and five days before the service is rendered. This is one of the best practices.

Train Your Staff 

Every member of the staff who contributes in any way to the process of revenue management should receive training on the significance of a high clean claim rate, the types of errors that frequently occur, and the strategies that are being developed to improve it. Your partner in medical billing or the manufacturer of the software you use should provide training both during and after the implementation process. Even if your business partners are putting in a lot of effort to enhance your clean claim rate, the biggest factor in how much progress you notice is how well-informed your staff is on effective billing procedures and how to make the most of medical billing software.

Claim Scrubbing Software Eliminates Human Error

A device that automatically scrapes and changes data can significantly cut down on expensive human errors. Claim denials can be the result of something as simple as omitting required demographic facts or spelling names incorrectly. An automated solution lessens the workload for employees working within the company and minimizes the number of mistakes made in the claim.

Look for Medical Billing Partner

The percentage of clean claims is such an important statistic for determining the overall effectiveness of your revenue cycle management. A fantastic way to get started is by forming a strategic alliance with a provider of RCM services with the express purpose of boosting the proportion of accurate claims. Because of this, your staff will be able to focus on activities that are more patient-critical, and you can be assured that someone is checking claims for errors. A medical billing partner will also take the essential procedures to guarantee that your percentage of clean claims is more than 90% at all times.

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