The healthcare scenario today has an important metric of quality - a high “clean” claim rate, that reflects compliance and precise payment. Thus Submitting a ‘Clean Claim’ is more predominant for any physician practice.
There are numerous factors that push reimbursement that does not require the regulations of a provider. When it comes to cash flow, there is absolutely no room for errors. Alterations occurring due to procedure bundling, reduction in the fee structures, etc. are some of the examples explaining the above claim.
An accurate & well documented 'Clean claim' can decrease the back-end cost of denials as well as promote reimbursement. Recognizing 'clean claims' is thus a part of the modernization process in the healthcare industry.
What are the criteria for Clean Claims?
• The latest available codes are to be used.
• Timely Submission of claims by licensed healthcare providers on the date of service.
• Make sure that the services are covered by the patient's insurance as well as if the coverage was in effect on the date of the healthcare service.
• Procedure codes are supported by diagnosis codes to eliminate questions about medical necessity.
• Information placed in the claim should be genuine and correctly placed.
• Check if the additional documents required are also included along with the claim
Here are a few tips that will help you clean healthcare claims to make a difference in your practice’s ongoing financial health:
• One wrong information or even a wrong code can make a claim 'unclean', ultimately affecting your revenue cycle. To Avoid this, educate your staff regarding the proper way to prepare claims the right way.
• Define a structure that provides support to the policy change and rapid rule to lessen the 'unclean' claim submission.
• Analyze the rejected claims to determine the errors in denials and underpayments.
• In order to create an efficient workflow by reducing the time consumed while re-working on corrections, categorize the claims according to the issues concerned.
• What the sorting of pre-billed claims and denials does, is helping the organization work effectively by using good analytics and proper reporting.
• Regularly update the software and systems for a smoother working, manageable system which adapts to all quality measures.
• One of the most overlooked points is to Know your payers and their payment policies well. A well communicative relationship will prove very helpful while resolving possible issues.
These suggestions can give you a better idea as to how to deal with 'clean claims'. As healthcare organizations are under continuous pressure due to the governmental requirements and general industrial requirements.