How to Improve Your Clean Claim Rate (4 Easy Steps)

Don’t know how to improve your clean claim rate? Here are the 4 easy steps to make your clean claim rate improve significantly with minimal effort.

A clean claim rate is a measure of the accuracy and efficiency of the medical claims submission process. It is an important indicator of the overall performance of the healthcare system, as it reflects the ability of healthcare providers and payers to work together smoothly and efficiently. For that reason, a high clean claim rate is essential for both healthcare providers and payers. For providers, a high clean claim rate means that they will be paid promptly for the services they provide, which is crucial for their financial stability. On the other hand, a low clean claim rate can lead to delays in payment and other issues that can put a financial strain on healthcare providers. For this reason, we bring you this guide in which we will reveal how to improve your clean claim rate in 4 easy steps. So let’s start:

What is a Clean Claim in Medical Billing?

In medical billing, a clean claim is a claim for reimbursement for medical services that have been submitted to a payer without errors or omissions. A clean claim includes all the necessary information and documentation required by the payer and is submitted in the proper format. The goal of a clean claim is to ensure that the claim is processed efficiently and that the healthcare provider is reimbursed on time. A clean claim can significantly help in reducing the risk of denied claims, which is a significant issue in the healthcare industry.

What is Considered a Good Clean Claim Rate?

A clean claim rate is a measure of the percentage of medical claims that are processed without errors or discrepancies. A good clean claim rate is generally considered to be at least 95%. A clean claim rate of 95% or higher indicates that the claims are being submitted and processed accurately and efficiently, which is very important for healthcare providers. A lower clean claim rate may indicate problems with the claims submission process, such as incomplete or inaccurate information, which can lead to delays in payment and other issues.

Why Maintaining a Clean Claim Rate is Important?

Maintaining a clean claim rate is important because it can affect the overall cost and reputation of a healthcare business. When a practice has a high clean claim rate that means it can process and pay out insurance claims efficiently and accurately. That helps keep costs down, as it reduces the need for additional staff to handle disputed or denied claims. Moreover, it helps improve business reputation, as customers are more likely to be satisfied with their claims experience.

On the other hand, a low clean claim rate indicates that the business is struggling to manage its claims process effectively, which can lead to higher costs and dissatisfaction among customers.

4 Easy Steps to Improve Your Clean Claim Rate In 2023

Verify Patient Information:

If you genuinely want to improve your clean claim rate then make sure you have all the correct and complete information about the patient before you submit the claim. That includes the patient’s name, date of birth, address, and insurance policy details.

When filling and submitting the form, make sure to double verify all the details to prevent any errors in medical billing.

Use CPT Codes Correctly:

CPT codes are used to describe the medical procedures and services provided to the patient. It is important to use the correct CPT codes when submitting a claim to ensure that the payer understands the services provided and can correctly process the claim.

Make sure that you are familiar with the latest edition of the CPT code manual and follow guidelines for code selection, as well as any applicable payer policies or guidelines.

Track Denied Claims:

If a claim is denied, it is good to follow up and find out the reason why it got denied. Common reasons for denied claims include incomplete or incorrect information, lack of pre-authorization, or services that are not covered by the patient’s insurance. Once you know the reason for the denial, you can correct the errors and significantly improve your clean claim rate.

Use Electronic Billing Systems:

Implementing electronic billing systems is another great way through which you can reduce errors and improve the clean claim rate. Moreover, they can help in providing valuable insights into the reasons for denied claims and help you identify patterns that may be causing claims to be denied so that you can prevent them in the future.

Conclusion:

By following the four steps that we discussed above, you know how to improve your clean claim rate and ensure that you are getting paid for the services you provide to your patients. It is important to keep in mind that improving your clean claim rate is an ongoing process, and it requires consistent effort and attention. However, the potential benefits of a higher clean claim rate such as increased revenue and a better reputation for your practice, make it well worth the effort.