When submitting claims for payment, it is important to be mindful of the fact that even minor mistakes can lead both to delays and claim rejections, so use both general information and more specialized data, sending everything timely and accurately. A recent study showed that claim denial rates increase in 2024 compared to the previous year so we need to get precise and complete case information.
In this blog we’ll talk about the clean claim submission process and why it matters to billers and the firms they represent
What is a Clean Claim?
In medical billing, claims contain numerous details according to the insurance company’s requirements. This insurance company allows clean claims to be processed by elucidating the submission of billing with such parameters as information that must be included in the wage lord’s claim. Therefore, the palms are treated as Clean claims and the cleansing process for this submits all necessary mechanical information making the claim settlement decisive.
Statutes & Laws
Clean claims meet insurance-specific requirements and are processed without the need to resubmit the case. The statistics show that the use of clean claims leads to fewer disputes with the insurance company and many more claims are approved. Lastly, this comprehensive set of timely and accurate information allows for clean claims to be automatically approved, thereby cutting administrative costs at the insurance firm.
Why Does It Matter?
- Reduced delays and rework
- Improves cash flow for healthcare providers
- Lowers administrative costs spent on appeals and corrections
Core Components of a Medical Claim
Patient’s Information: The patient’s information comprises name, age, and insurance policies
Provider Information: A medical report on a doctor or a healthcare assistant comprising NPI and location details.
Diagnosis and Procedure Codes: The appropriate use of claim-paying diagnoses using ICD-10 to classify claims, and CPT codes for procedures is also important.
Charges: The cost of treatment can be its critical aspect so a breakdown of the charges, if any, is appropriate.
Insurance details: The policy number, provided by the insurance company and coverage details.
Steps in Filling and Submitting Clean Claims
Step 1: Patient Registration
Gather all necessary patient demographics and insurance coverage information that is precise.
Check to ascertain if the services rendered will be covered under the insurance policy.
Step 2: Ascertaining Liability
If there is any out-of-pocket payment by the patient, inform them accordingly.
Ensure that the patient is informed about services not included in the insurance before commencing any treatment.
Step 3: Medical Coding
Apply appropriate and current coding of ICD-10 and CPT about the diagnosis and the relevant treatment provided.
Maintain the use of certified coders who will assist in maintaining compliance with the standards policy set forth by the payers.
Step 4: Submission of Claims for Review
Check for errors and omissions and overall completeness of the claims
Make electronic submissions through clearinghouses, which eliminates various errors and cuts down the processing time It is fast and effective.
Top Most Reason for the Claim Denials
The following are the main reasons for the claim denials.
Incorrect or Missing Information: Patient and Insurance details have errors.
Coding Errors: ICD-10 and CPT codes were wrongly used.
Lack of Pre-Authorization: Some procedures are performed that require approval to be taken beforehand.
Claims outside the limit: The company claims oversteps the deadlines set by the insurance company.
Medical services not approved: Services that the insurer feels are not needed have been provided.
Tips that can be used to Cut Down on Claim Denials
Automatic Insurance Verification: This includes the use of software and will automatically check for insurance coverage right before the service is undertaken.
Employee Training: The staff should be encouraged to undergo constant training that outlines the updates in medical coding and requirements for payers.
Quality Control Systems In Place: Claim double checks must become standard routine.
Amended Medicine: Use of tools and systems in the submission of claims for the detection of errors.
Identify and Study Patterns: Attend to persistent problems by examining patterns of denial regularly.
Electronic vs. Paper Claims Electronic Paper Claims:
Paper Claims: High speed and efficiency Manual processing entails a longer period. Automation has led to a reduction in errors. High error rate Due to automation, the burden has been minimized High degree of manual effort is required.
Conclusion
It is not sufficient to consider the submission of sparkling claims as a task within the multi-faceted medical billing cycle- it is the heartbeat of a practice’s economics. Perhaps 100 levels of clean claims are not attainable, but even little steps will cut down on the denials and boost effectiveness. If you bear in mind these steps and tips you will get more money and do not spend hours seeking fewer corners.
Are you in need of elevating your claim submission process? Look through our sophisticated solutions to optimize your reimbursements now.
