A clean claim in medical billing and coding is known as a claim that does not contain errors and is in a timely submitted. When it comes to submitting the claims, you should be highly vigilant that the claim is 100% accurate. The report should not contain any kind of error otherwise it will be considered rejected. Come with me to explore more about how to achieve a high clean claim rate and what is clean claims medical billing in detail.
Core Concept of Clean Claims in Medical Billing
The majority of the people are unfamiliar with the clean claim definition. Basically, a claim that is free from errors and omissions is known as a clean claim. The clean claim has more chances to be approved and processed as soon as possible. However, to ensure that a claim is clean you should take several steps including checking the code accuracy and fixing the billing errors.
Another factor also plays a role, the information of the patient and the insurance policies. Ensure that the information of the patient is 100% accurate and the policies of the insurance plan are friendly to the treatment that your healthcare center has provided. A claim cannot be cleared until it is checked multiple times.
When A Claim Is Considered Clean?
- If it includes the correct details of patients, insurance information, and provider credentials.
- If it has accurate procedure guidelines and diagnosis codes.
- If it meets the payer’s guidelines as well as regulations.
- If it does not contain errors or there is missing information.
- If the bill is submitted within the required timeframe.
Why Clean Claims Matter in Medical Billing?
There are several factors that make clean claims important for medical billing. For example, they are important for accurate billing details and payments. If the bills contain errors and issues, you cannot get the reimbursement. Additionally, clean claims are significant for improving the efficiency of the billing process.
The clean claims are important for preventing the rejections and denials. They reduce the time spent on checking the accuracy of the claims. With the help of clean billing, you can speed up the billing and reimbursement process. Lastly, the clean claims improve the revenue cycle management which helps your business to make incredible growth.
How to Achieve a High Clean Claim Rate
A strategic approach is needed to maintain a high clean claims medical billing rate. There are several factors involved ie clean claims including accurate patient information, use of correct codes, and timely submission. Here are some main stepping stones to enhance the accuracy and efficiency of medical claims processing:
1. Ensure Accurate Patient Information
This includes checking the patient’s name, date of birth, insurance ID, and policy number before submitting a claim. Minor errors will result in claim rejections.
2. Use Correct Coding Practices
Technically, one of the main reasons for claim denials occurs when there are medical coding errors. Check all the procedure codes (CPT or HCPCS) and the diagnosis codes (ICD-10) are correct and are according to the current regulations.
3. Verify Insurance Eligibility
Check whether your patient’s insurance plan covers the procedure before rendering services. The benefits in advance reduce the chances of coverage issues that lead to the rejection of the claim.
4. Timely Claims filing limits should be submitted.
There are different deadlines for the submission of claims from every insurance provider. Submitting claims as soon as possible helps the claims be processed quickly with no delays.
5. Conduct Regular Audits
Internal audits regularly determine which errors in claims submission occur repeatedly. The clean claim definition is checked before submission and the approval rate increases.
6. Leverage Billing Software
Advanced medical billing software will make your claims submission processes more streamlined by taking care of all these and more; including making certain that you are submitting claims that are accurate, incorrect formatting, and adhering to payer rules.
The Role of Med Brigade in Clean Claims Processing
Med Brigade specializes in clean claims medical billing optimization to healthcare providers to get faster reimbursements and fewer denials. With the help of our services, you can increase the acceptance ratio and take your business to the heights of the sky. Our expert staff ensures that the claims are 100% accurate and error-free. We use next-level tools to check the code accuracy and the claim errors.
We assist with:
- Accurate claim submission and perfect coding verification.
- Real-time eligibility checks.
- Prevention of rejections during the claim audit.
- Ensuring timely follow-ups with enlisted means of automation.
Final Thoughts
Healthcare needs to understand what is a clean claim in medical billing. Following the best practices and hiring experts like Med Brigade will help increase the provider’s clean claims medical billing rate and provide a steady flow of revenue. Med Brigade’s goal is to help if you want to improve your billing efficiency and minimize your claim denials.