Steps To Increasing Your Clean Claim Rate Submission

Do you know that having a clean claim rate submission is key to maximizing the revenue of your healthcare practice? Therefore, it is important to pay careful attention to the percentage and rate of claim denials and first-pass claims acceptance. While claims denials do happen due to various reasons, it is important to take action and pay close attention to the reason for them and take the necessary steps to achieve cleaner claims submission rates. With more accurate and cleaner claims, the medical billing procedure takes a shorter time to process, and your practice will receive your claims quicker from the third-party payer.

Update and Check Patients’ Information and Eligibility Regularly

Before submitting any claims, the first rule of thumb should be to verify their personal information and ensure that all their details are accurate and up-to-date. This information is key to allowing you to deliver the highest-quality healthcare service to your patients and determine the result of the claim submission.

Your healthcare staff should be trained to always verify the patient’s eligibility for coverage, insurance policy information, demographics such as name and occupation, residential and billing address, as these would make all the difference in the outcome. Ideally, the patient’s eligibility should also be verified two days before the date of service (DOS) to lower the likelihood of claim denials and increase the chances of successful claim submission. This would also lead to a decrease in write-offs and improve your quality of service.

Enhance Your Pre-Authorization Process

In the pre-authorization stage, information such as the type of service provided, the requirement of prior authorization for a procedure to be performed, and eligibility for insurance coverage should be verified. Checking the accuracy of these details is key to reducing your rate of claim denials and will significantly maximize your revenue. We suggest investing in a system that can provide up-to-date pre-authorization information to flag out denial cases promptly. This is crucial as it can provide the healthcare provider with the right information to take action before the date of service (DOS).

Understand the Current Coding Regulations

While medical billing departments can empathize with the complexity of the ever-changing medical codes, it is critical to ensure that your staff stays updated on the current coding regulations for a cleaner claim rate submission. Using an outdated or wrong code for the wrong type of services your practice performs will delay the medical billing process or lead to claim denial.

If it is possible, you could consider outsourcing for a medical billing company that could aid with claim scrubbing to identify and resolve any errors immediately. Some healthcare practices and institutions have also incorporated electronic claim submission to expedite the claim submission process in recent years.

Prioritize Proper Medical Documentation

The first rule to any successful claim submission is prioritizing and ensuring proper medical documentation. Therefore, we recommend enforcing regular quality checks and claim scrubbing to identify personal particulars and medical coding errors. In addition, information such as medical history, demographic details, and case history should be properly documented and are key to expediting the claim processing. Unfortunately, in some cases, minor errors and mistakes can significantly delay reimbursement and affect your practice’s cash flow and revenue.

Your One-Stop Medical Billing Solution

KR Billing Solutions prides itself in being at the forefront of the medical billing industry. We understand the difficulties that many practices face in maintaining a clean claim rate submission and constantly staying up to date with the latest coding standards and regulations. Therefore, we are here to provide you with a wide range of medical billing services ranging from claim scrubbing and submission to AR follow-up to denial management and appeals.