In the medical Billing, healthcare Industry Revenue cycle is depended on how AR is paid. If AR is paid in a timely way then Revenue cycle is managed properly and if not it may bear losses. The practioners have to take care regarding their revenue cycle and one such way by which they can improve the efficiency is to submit clean claims to the insurers which a renowned medical billing and coding company can perform flawlessly.
What is clean Claim?
Clean claim is characterised as one specific insurance claim, which is proper and correct and has no errors. Clean claim criteria are different from payer to payer but the general clean claim includes the following which reputed medical billing companies follow strictly.
- A clean claim is usually submitted by the licensed Practioner.
- The treatment code of the payment and the standard procedure codes are parallel and updated to
- support each other so as there is no room for error. The medical coding specialists take care of this.
- The Insurance coverage of the claim was effective from the date of practioners service, which is covered in the patient’s insurance.
- The information filled is correct and properly written in the fields stated in the form of the claim.
- The Insurance Payer is identified and bears an ID number along with the mail address, which should be existing and correct.
- If any additional documents are needed by the carrier then they should be attach along with the claim.
The clean claims management is a bit difficult task but it is an important one which medical billing companies do correctly. It helps in decreasing the denials, helps your practice get timely payment and enhances the efficacy of your revenue cycle.
Reasons for Claim Rejection
The insurers should follow all the rules and regulations and the standard format and if not the claims get denied. At times, the claims are rejected for no particular reasons but usually clean claims are rejected for below stated reasons:-
- Late submission of the documents or improper documentation
- Expiry of the service date
- Lack of prior approval for hefty treatments
- Lacking additional documents
The practioners should ensure having proper claims procedures. The medical billing and coding staff do this appropriately, communicate, understand the main aim, and be accountable for the revenue cycle management. The coding and upgradations should be done as per the changes in rules and standards so as to avoid the risk of getting denied claims. They are well aware of the coding regulations and HIPPA guidelines so your practice doesn’t suffer anywhere.
The staff is well trained and make proper use of softwares to have easy accessibility of the data reducing inefficiency and inaccuracy. Thus, clean claims are submitted at least 99 % of the times and the efficiency of revenue cycle management are enhanced greatly.