What Is a Clean Claim in Medical Billing?

Clean Claims are Key to a Healthy Revenue Cycle

One very important factor of an efficient medical practice billing process is the submission of clean claims to payers, both private and governmental. Working towards submitting claims that are free of errors the first time around will reduce claim denials and raise your reimbursement rate. Furthermore, your practice will avoid the time and expense related to resubmitting claims and appealing denials. Raising the clean claim rate can be a challenge, however, especially with the new codes introduced last year by ICD-10 and the fact that individual payers each have their own complex set of rules that often change.

Clean Claims

What is a Clean Claim?

A clean insurance claim is free of errors when initially submitted and can be processed by the payer without the need for any additional information. The more clean claims your practice submits, the fewer rejections it will experience and the faster payments will arrive. In the simplest terms, a clean insurance claim must be:

If your billing system can effectively manage those three criteria it will address the major reasons for claim denials. These include incomplete patient demographics, missing documentation and incorrect diagnostic and treatment codes. Let us examine some ways to submit more clean claims and lower the number of claim rejections. By working on the areas discussed below you can expect to see improvement of your practice’s billing.

Claim Scrubbing

Reviewing each and every claim before it goes out the door is critical part of the billing process. Making sure every claim is “scrubbed clean” before being submitted will cut deeply into the time and expense of chasing payments afterward. Double check each field for completeness, review diagnostic and treatment codes for accuracy and otherwise insure compliance with the payer’s processes and regulations. While scrubbing the claim also pay attention to demographic information. Typos and carelessness can cause easily avoided mistakes when entering the patient’s name, date of birth, Social Security Number and insurance ID number.

Study the Analytics

Part of a proper billing assessment should include studying analytics and reports. Good analytics allow a medical practice to find trends that are causing accounts receivables to grow in size and time. They can help in determining which problems are in house and which are due to outside factors that must be addressed. By reviewing billing reports it is possible to uncover unpublished or vague rules that a payer uses in their claims process.

Implement Policy

Consistently submitting clean claims will require continuous evaluation and improving of the revenue cycle. Well defined policies and procedures are essential. Consider incorporating some of these into your process:

ProMD Medical Billing can perform a thorough billing assessment as well as a full practice assessment. If you would like help in maintaining a high clean claim rate, consider hiring a team that has over a decade of experience raising collection rates for medical practices.

ProMD Medical Billing is happy to help with your billing assessment needs so you can maximize profits and increase patient satisfaction. To learn more about how ProMD can make your practice run like a well-oiled machine, call 866-960-9558 or fill out our online form to request a billing assessment.

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