Episode 42: Maximize Your Revenue With Clean Claims

The Private Medical Practice Academy

Submitting clean claims is key to maximizing your ability to collect the money that is due to you.

What is a clean claim?

The claim for payment has to be submitted via an acceptable claim form or electronic format with all required fields completed with accurate and complete information in accordance with the insurer's requirements.
What is the significance of a clean claim?

Most practices have a clean-claim submission rate of 75-85% which means that 15-25% of submitted claims are not clean.
Claim rejections actually cost you money. When a claim is rejected, it means that those claims have to be reworked and resubmitted. Your clean claim rate should be 95%. Anything lower than this means that you are losing money.

Your clean claims rate directly affects your practice’s overall revenue. Problematic billing and coding practices on result in delayed or denied claims that can have devastating results for your practice.

Let’s put things in perspective. Every claim that is not paid on the first submittal wastes your practice’s valuable time and money. Many rejected claims are resubmitted multiple times, often without their errors even being addressed or corrected. I also want to point out that when a rejected claim needs to be reworked beyond its timely filing deadline you end up not getting paid.

What Clean Claim Rate should do I need (want)?

In the ideal world you would have a 100% clean claim rate. But let's be real--errors happen. That said, you should not be satisfied with a clean claims rate under 95%, and especially anything under 90%. Anything above a 5% claims rate is costing your business money and time. Your overall profitability depends on having your clean claims rate under control.

So how do you achieve that 95% clean claims rate?

• Keep patient information updated
• Verify eligibility prior to the date of service
• Provide detailed documentation of medical information
• Be mindful of insurance claim filing timelines
• Double-check modifiers

You want and deserve to be paid for the work you do. Having a 95% clean claim rate will increase your profitability by increasing your collections and decreasing the expenses incurred collecting your money. And, of course, it will shorten your revenue cycle—said another way—you’ll get your money faster.

If you want to learn how to implement the p

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