How to Achieve Highest Clean Claim Rate?

Do you have any idea about your practice’s clean claim submission rate? If you don’t know then you need to know and if it’s not highest means if it’s not at least above 90 to 95% then you need to work on it. We at Medisys help practices to achieve highest clean claim.

Rejections in claims are costly as you are losing revenue and furthering expenses by having to rework on those rejected claims. Some practices have a clean claim submission rate between 80% and 85%, it means somewhere these practices 15%-20% claims submitted each month have to be reworked on twice minimum. Now you may thinking how we can cross 90% clean claim submission rate? We have suggested some solutions on it.

Updated Patient Information

If you have patient information and that information is not updated or incorrect then you may have chances to use wrong information while submitting claims. Contact information, insurance carrier and lot of patient information can change. With inaccurate patient information being a lead cause of denied claims, it’s crucial to have patient confirm or update their current information prior to receiving services. Use precise documentation to avoid delays and to verify patient information in advance.

Eligibility Verification prior to Date of Service

Physicians staff may assume that no changes in patient information who visit a provider frequently. However, this is the often cause of denial. To submit clean claim you need to collect and confirm patient’s primary, secondary and even tertiary insurance at least two to three days prior to their scheduled service.

It’s important to confirm any in or out of network benefits, copays or deductibles as well.

Detailed documentation of medical information

The other way to help boost your clean claims rate is to confirm you have the most updated and detailed medical information possible. This consist proper documentation of procedures, case history, medication history and other similar information. These documents are useful to use as supplemental records to process clean claims if needed.

Double check modifiers

It’s important to reconfirm of modifier usage either they are applied correctly and to the right procedure. This can be another way to help ensure this is done efficiently is to create guideline of customized National Correct Coding Initiative (NCCI) edits for reference.

Read more about modifier usage: Steps to Follow Before Choosing Modifier 59

If your practice has highest clean claims then the result is faster reimbursements and ultimately more revenue. This information will help you to keep highest clean claim submission rate in your practice.

Are you looking professional assistance for getting your clean claims rate up? Contact Medisys today and our expert medical billing team will help you to boost your practice collections.

About Medisys

We are a group of medical billing experts who offer comprehensive billing and coding services to doctors, physicians & hospitals. We provide end to end billing and coding solutions. Medisys Data Solutions RCM solutions ensures that the providers recover every $ they are entitled to. Our vision for the providers is “You Cure. We $ecure.”

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