Improve Your Practice’s Clean Claims Rate in 4 Steps

Improve Your Practice’s Clean Claims Rate in 4 Steps

Clean claims drive the overall revenue of health care providers and provide a healthy cash flow. Each time claims get denied, they weigh down your accounts and hold up the revenue your medical practice brings in. Denials become costly from a valuable time and financial perspective - so getting it right is important to your revenue stream, keeping your practice moving forward efficiently.

Claims payment is a key part of the healthcare revenue cycle

48% of healthcare leaders in an MGMA study identified claims payment as the biggest revenue cycle management challenge. With claims payment being a top of mind concern for many healthcare providers, and denials being another top concern, clean claims make a huge impact on healthcare providers’ success.

Keep your team focused on providing top-notch patient care by achieving clean claims the first time around. At NCDS Medical Billing, we have identified the top methods for health care providers to successfully achieve clean claims. Below, we share exactly what clean claims are and break down the premier strategies to increase your clean claims rate.

Review Denied Claims

Denials should not be looked at as a lost cause - instead, they’re a fantastic learning opportunity to prevent future mistakes. Past that, it’s worth staying on top of denials to see if denied claims can be turned around.

The AAPC claims calculator is a useful resource to determine how much your practice loses on denied claims and reworking denied claims. The combination of denials and reworking these denials adds up quickly. For 500 reworked claims per year at the average reworking cost of $25/claim with two physicians in practice, the cost of reworking adds up to $25000 per year.

Track and Report Denials

Make a point to track and report all the denied claims your practice receives. By quantifying the types of denials you receive and understanding when, why, and how these denials happen, there is a huge learning opportunity to improve your clean claim rate.

Identify Common Denials

For a healthcare provider, understanding where denials are coming from can help also streamline and template out the best responses to particular denials. Whether it’s incomplete medical documentation, an inaccurate insurance claim, or other errors, you can dig in on what the common reasons are for such recurring issues. By identifying common denials, which payers seem to deny for which reasons, and staying on top of what payers need, your team will increase efficiency when it comes to making claims the first time. 

Catch New Denials Early

Identifying new denials early in the process increases likelihood that these denials can be turned around. Staying on top of new denials helps ensure you can still get timely payment from the payer. Being aware and attentive of denials increases your practice’s overall financial health. Contacting payers who have denied claims as soon as possible helps provide clarification about what that payer needs and reduces days in accounts receivable. This clarification can allow for your team to resubmit a clean claim. Stay informed about what payers are looking for when accepting appeals.

NCDS SOLUTION: According to the American Academy of Family Physicians, with the cost of rebilling a claim at $25 or more, the practice of reviewing denied claims needs to be efficient. NCDS uses a priority RMT (Receivables Management Task) system to identify, prioritize, track, and analyze denials to optimize the efforts of billing teams and produce the best results.

Verify Patient Information

Verifying patient information is the #1 way to achieve clean claims and prevent denials. In addition to understanding your denials, appealing denied claims, and knowing what your payers are looking for in clean claim coding, verifying that your patient information is accurate and up to date increases your clean claim rate.

Missing Info leads denial reasons according to MGMA poll

According to an MGMA poll, missing info and prior authorization are the top two reasons for denials. The top reason for denials, “Missing Info”, is avoidable through regular patient verification.

Review Patient Information

Health care providers need to validate your patients’ contact information regularly. Always have patients confirm their information is up to date, and verify their demographics. Incomplete clinical documentation is a regular cause of denials. Confirm you have all necessary medical records and provide that information as well if needed.

Determine Prior Authorization

Getting prior authorization as soon as possible helps achieve clean claims. Determine all the requirements for reimbursement up front so your practice and your patients have all the information necessary for approval.

Confirm Patient Eligibility

Verify your patients’ insurance during every visit. Ensure your practice knows what will be covered with their insurance and find the right payer the first time.

Conduct Quality Checks

Before submitting a claim, ensure all data is accurately input with all necessary fields filled in. A verification process to ensure that all information is accurate and complete will make all the difference when it comes to your revenue cycle.

NCDS SOLUTION: Tools for verifying insurance eligibility digitally and establishing a patient portal are available to you through the NCDS Client Logins. NCDS also offers outsourced Verification Of Benefits and Claim Prior Authorization services to help streamline your front office processes, save your staff time, reduce denials, and improve your clean claim rate.

Office Training and Coordination

Benefits of Clear Role Communication

Coordinating, communicating, and educating your office staff about best practices and operations to file clean claims is the key to a strong clean and accurate claims rate.

All staff members need to know what their duty is when it comes to their particular function in your practice and its operations. All roles in your practice need to be on the same page about what they need to do in their particular role to have a smooth running claims function. Each role has a key component in your practice and how they help move the claims process along.

Educate and Train Staff on Claims Submission and Common Billing Practices

Ensure your staff is trained up on your latest process requirements. Your front office staff, doctors, and back office staff all must be trained and up to date on what their role is in your operations.

Your full staff must be educated on:

• Insurances accepted in your offices
• Services provided by your practice
• Services NOT provided by your practice

Make sure staff members who work on filing medical claims and billing are up to date on efficient and proper documentation and coding practices when submitting claims.

Keep your stuff fully updated on their certifications and continue to provide training and education to your office. Communication and education are imperative to your office’s success and functionality.

NCDS Solution: Contact NCDS to set up a discovery workshop to review front and back office best practices in great detail to help your staff manage patient information and payment collections onsite, effectively and efficiently. We also offer FREE onsite and remote consultations to assess your practice's processes.

Engage an Expert Medical Billing Partner

Medical billing companies implement all of the best practices and tactics for achieving a high clean claims rate. Between preventing and mitigating denials, increasing clean claims, and knowing the world of medical billing inside and out, the right partner can keep you safe from inefficient billing practices and significantly enhance your practice’s revenue cycle.

Contact NCDS Medical Billing to talk about how we can work together to build a continuous process of clean claims submission and improve your financial performance and outcomes.

Questions?