Do You Know What a Clean Claim Is in Medical Billing Services

Do You Know What a “Clean Claim” Is in Medical Billing Services?

What is Clean Claim?

A clean claim needs to be submitted without any issues and if it doesn’t delay the payment. An increased Clean Claim Rate indicates that the information is collected and analyzed within the high quality of an Electronic Health Record (EHR). It implies that the claim prices are completely accurate.

It would be irrespective of how a CCR is achieved. Even though the improved initial accuracy, the routine of custom claim intakes is. It results in a shorter time to pay with less manual labor or lower operational cost.

In Medical Billing Services What Does “Clean Claim” Imply?

In your medical practice, the clean claim raises your revenue and cash flow but the question is what do they imply? We will define what is a clean claim in medical billing services and how to submit clean claims so, that you can submit them correctly the first time.

“A claim that must be submitted without any inconsistencies and other factors such as unimportant documentation that would prevent payment is known as a clean claim”.

Several elements and medical bills are required by the clean claim and they are turned down if the elements are unaccounted for, inaccurate, and incomprehensible. A clean claim meets all of the following areas: Acknowledge the health facility, medical provider, residential healthcare, or a provider of durable medical billing services in considerable detail for the verification of the affiliation station, if necessary, and includes any recognizing counts.

  • Identification of the patient and health plan payment fee sufficiently
  • A request for insurance coverage submitted on behalf of a qualified person.
  • Provide support, where needed, for the medical need and suitability of the services rendered.
  • Provide sufficient details to demonstrate that prior authorization has been acquired if it is necessary for particular patient care.
  • Uses a generally agreed technique or service coding system to identify the services rendered

 What Are the Effects of Clean Claims on The Healthcare Practice?

After getting to know the role of clean claims in medical billing services let’s take a tour of the effect of clean claims. The overall revenue of your medical practice is directly impacted by your clean claims rate. Your team’s questionable billing and coding procedures may result in delayed or rejected claims, which can be disastrous for healthcare operations. Many rejected claims are resubmitted numerous times, frequently with flaws that are not attempted to be addressed or corrected. Legal problems may also arise from claims that are submitted incorrectly. Your medical practice may be investigated for possible fraud and misconduct if it submits excessively incomplete claims.

Importance of Clean Claims 

Along with the clean claim in medical billing services, it’s compulsory to know its importance as well. The inability to report clean claims, or claims that pass through the clearinghouse, reach the payer, and negatively affect the practice’s income and cash flow. A significant share of claims submitted by medical treatments is continuously denied when they reach the clearinghouse or insurer.

By incorporating coding principles and claim scrubbing functionality, a medical practice’s claim submission can face a reasonably low number of rejections. The following claim errors, claim rejections, and denials—which are typically displayed on an explanation of benefits (EOB) or electronic remittance (ERA) advice—are reduced by claim scrubbing:

  • For the service date, CPT code is an inaccurate
  • The patient treatment code is missing
  • Incorrect member ID

Verify all billable codes when updated CPT and ICD codes are announced to reduce inconsistencies. Also, noting modifications to payer policies and guiding principles will guarantee accurate coding and shorten wait times for patient payments.

If the claim leaves your practice management system “clean” upon initial submission, the time it takes to get paid by the payer can be cut down.

What Are the Steps to Ensure Clean Claims?

When changed CPT and ICD codes are issued, make sure you double-check all billable codes to reduce discrepancies. Also, noting modifications to payer policies and guiding principles will guarantee accurate coding and shorten wait times for patient payments. If the claim enters your practice management system “clean” on the first submission, the time it takes to get paid by the payer can be cut down.

  • Ensure patient information is correct
  • Perform quality checks
  • Follow updated coding regulations

End Note

Our final question will be about what constitutes a clean claim in medical billing. It can be difficult to submit a medical billing claim. The claim processing flow is straightforward and encouraging when it is well-managed. Clean claims lead to fewer claim denials, which shortens the time it takes for money to be received.

A sustainable cash flow for healthcare providers is ensured by clean claims, which drive overall income. Every time a claim is rejected, it adds weight to your accounts and lowers the amount of money your medical practice makes. Denials are expensive in terms of both money and valuable time.

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