What is your biggest revenue cycle challenge? Is it Prior authorization? Rising claim denials? Staffing Issues? Higher accounts receivable (A/R)? As per the Medical Group Management Association’s most recent MGMA Stat poll, of the 825 healthcare leaders surveyed, about 48% considered claims payment the biggest challenge in their billing cycle. One common issue discovered was manual work on accounts which often leads to errors and drives denial rates.
Credit: Mgma.com
It shows that the traditional manual revenue cycle management (RCM) process may not be enough to support insurance collections. Each time a claim gets denied, they weigh down your accounts and hold up the revenue your practice brings in. All this can be avoided by streamlining your revenue cycle processes and submitting clean claims for every service rendered to a patient.
What is a clean claim?
A clean claim is defined as a claim that is accurate, complete and admitted in the first go by your clearing house. Providers should aim for a 95% or higher clean claims ratio to maintain good financial health.
At Jindal Healthcare, we have identified the top 3 methods for healthcare providers to successfully achieve clean claims; in more than 98% of the cases.
Best practices for achieving clean claims
Verify patient information
Healthcare providers need to properly collect, verify and manage patient health information, not only as a stepping stone towards submitting clean claims but also to improve medical record accuracy and comply with HIPAA. In nearly 27% of the cases, registration and eligibility remain the top reason for denials. Therefore, it’s vital to ensure that all patient information is accurate, including their name, DOB, medical history and insurance information. This can help prevent errors and delays in the claims process.
Using standardized coding and submitting claims promptly
After using ICD-11 & CPT codes to accurately code the diagnosis or medications provided to the patient, it’s essential to leverage the help of a claim scrubber. Claim scrubbing verifies that all CPT codes in a medical claim are accurate and the claim is filed per the insurance payor’s guidelines. But all of it will go in vain if the claims aren’t submitted promptly and, most importantly, digitally. Delays can occur if claims are submitted after the deadline or if they need to be submitted the first time correctly.
Analyzing historical data
By reviewing historical data, providers can identify inefficiencies, errors, and discrepancies in the claims process that may contribute to denials or rejections. It can help you streamline processes, optimize coding practices, reduce manual errors, increase efficiency, and ultimately improve patient outcomes.
Conclusion: Engage an Expert Revenue Cycle Management Partner
It is difficult for any organization to manage all aspects of the revenue cycle. Specifically in the healthcare industry, which demands empathy, passion, and the ability to provide patient-centered care, work in interdisciplinary teams and utilize informatics. But with rising hiring costs and revenue cycle staffing issues, healthcare practices can consider partnering with an experienced and trusted medical coding and billing solutions provider.
Between assessing different payor guidelines and ICD-11 and CPT codes, preventing and mitigating denials, and increasing the clean claims rate, the right RCM partner can help process claims more efficiently and promptly and enhance your practice’s financial health. At Jindal Healthcare, we analyze a practice’s EHR using HealthX, an AI-based tool, to prioritize and submit a clean claims rate of over 98%. Learn how we recently helped a pain group reduce their average claims pending ratio by 50%, process claims timely & improve revenue growth by 30%.
