Clean Claims Rate: Why Does It Matter To Your Holistic Practice?
If your holistic practice’s billing staff isn’t diligent with billing practices, mistakes such as upcoding, downcoding, and inaccurate information can go undetected until it’s too late. This can lead to a high number of rejected claims and ultimately impact your practice’s clean claims rate. Ensuring accurate billing and coding can protect your holistic practice from fines and inefficient billing practices that puts your practice at risk.
What is a Clean Claims Rate?
Your holistic practice’s clean claim ratio is the average number of claims paid upon the first submission. Every provider would love to reach a percentage above 95, but it’s about more than just reaching that number – it’s about streamlining your practice!
Holistic practice budgets are tight, and your staff’s time is the most precious resource you have. So if your clean claims rate is less than 85%, it means your staff is likely having to spend extra time on identifying denial reasons, coordinating with payers, and re-submitting claims. Overall, the clean claims rate directly affects your holistic practice’s overall revenue cycle.
How Do Clean Claims Impact Holistic Practices?
Every claim that is not paid on the first submission wastes your holistic practice’s valuable time and money. The Medical Group Management Association (MGMA) estimates that the average cost to re-work a claim that has been rejected or denied is $25 for each claim. If your integrative healthcare practice has to rework 100 claims per month, then it costs your practice an average of $2,500 a month to work on unclean claims; that’s an estimated $30,000 a year!
Many rejected claims are resubmitted multiple times, often without their errors even being addressed or corrected. This creates the potential for further revenue losses, such as when your holistic practice has a rejected claim that needs to be reworked beyond its timely filing deadline.
Additionally, inaccurately submitted claims can result in legal trouble. If your holistic practice submits too many improperly filled out claims, you can be flagged for potential fraud and abuse. The U.S. Department of Justice (DOJ) enforces laws, such as the False Claims Act and Anti-Kickback Statute, to crack down on coding abuse like improperly used modifiers, overcharged services, and more. In fact, fraudulent claims can cost your holistic practice thousands of dollars in fines!
What Is a Strong Clean Claims Rate?
Holistic practices should strive for a 95% clean claims rate, however, few practices actually reach that target goal. Most practices receive reimbursements the first time a claim is submitted for approximately 75% to 85% of claims they bill, which means about one-quarter of claims are denied or delayed due to errors or incomplete documentation.
Some studies have found that holistic practices have a clean claims ratio as low as 65% – resulting in 35% of bills needing to be redone. This translates to upwards of $20 billion per year in either delayed or permanently lost reimbursement in the United States alone.
You should not be satisfied with a clean claims rate under 95%, and especially anything under 90%. Although errors are bound to happen, anything above a 5% unclean claims rate is costing your holistic practice money and time. By keeping your clean claims standard high, you can increase your clean claims ratio and overall profitability.
Best Practices to Achieve a 95% Clean Claims Rate
How can your holistic practice achieve a 95% clean claims rate? Though this may seem like a lofty goal, there are some medical billing strategies that your practice can implement to help improve your clean claims rate – and your overall revenue cycle management!
Keep Patient Information Updated
From contact information to insurance carriers and more, there’s a lot of patient information that can change. With inaccurate patient data being a lead cause of denied claims, it’s crucial to have patients confirm or update their current information before receiving services. To help verify patient information in advance, use precise documentation to avoid delays and be sure to have patients update their forms at every visit, or even sooner with automated reminders.
Be Mindful of Insurance Claim Filing Timelines
Filing claims usually requires submitting within a tight window. Any time a claim is submitted outside of that window means an increase in denied claims. Ensure your holistic practice’s administrative team is on the same page with maintaining deadlines.
If your goal is to have a near-perfect clean claim ratio for your holistic practice, one of the best ways to do that is to pay attention to claim deadlines. If there are any issues associated with patient coverage prior to their date of service, resolve them so the claim is not submitted late. One best practice is to aim for authorization between three and five days prior to service.
Verify Billing Modifiers
When it comes to your modifier usage, it’s important to confirm that you’ve applied them correctly and to the right procedure. One way to help ensure this is done efficiently is to create a guideline of customized National Correct Coding Initiative (NCCI) edits for reference. Having a compilation of frequently-used codes and modifiers means your administrative team won’t have to search through thousands of codes to find the exact one they’re looking for. Overall, this will help optimize the billing process of your holistic practice!
Increase Your Clean Claims With Holistic Billing!
By using these tips to boost your holistic practice’s clean claims rate, you’re sure to make the most of your practice’s revenue in the future. However, these tips definitely require time and effort to do it successfully. If you’re in need of expert medical billing services, let Holistic Billing Services be your go-to source for an error-free billing solution.
With decades of experience dealing with a broad range of medical billing issues for all kinds of holistic practices, the team at HBS has seen just about every kind of medical billing error an organization can make. That’s why our clients trust us to help them manage their insurance claims to ensure they’ll be accepted as clean claims on the first attempt, avoiding lengthy back and forth negotiations with the insurance company. And best of all, you’ll avoid the scrutiny of federal and state auditors.
Contact us today to learn about Holistic Billing Services medical insurance billing services and find out how we can help you increase your clean claims rate!
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