The clean Claim ratio is the average number of the first submission cleared claims. An average of 95 percent or above is an excellent claim clearing ratio. If your clean claims ratio is below 85 percent, your staff is spending a lot of time identifying denial reasons, communicating with insurance companies and resubmitting claims. The practice of resubmissions requires resubmission costs and time usage. It is pretty challenging to maintain in-house human resources and train them frequently. Outsourcing the best medical billing firm will save you time and money. Here are some tips that can boost your clean claims ratio.
Follow the top Best Practices to Boost Your Clean Claim ratios
1. Update Patient Information
The first step in the claims submission is patient data. Accurate patient data ensures claim clearance, whereas inaccurate patient data leads to denials. Healthcare practices can update the patient’s information after confirmation from them. Practices should not wait for the patient to tell the information. Make sure to update the patient information at regular intervals. You can send reminders or emails for the confirmation of data.
2. Timely Submissions
Although an accurate and complete claim is the ultimate key to clean claims, maintain a timeline before submitting claims. Timely submission of a claim helps you in clearing claims earlier. Verify patient eligibility before the date of services. It will not take more than a week to complete the submission process.
3. Common Corrections
How quickly can you identify issues in your claims? Are you taking help from any software to scrub your data before submission? How much your claim contains incorrect or missing fields? These standard quality checkups keep your claims clean and make reimbursements easy. Maintain a clean claim submission process. Deploy both human and AI-Resources to check all the details before submitting the claim.
4. Accurate Coding
Incorrect coding either it is intentional or unintentional, will lead to the denials. Unintentional incorrect coding means your coder has either entered old codes or wrongly entered, or a character from the code is missing. Intentional erroneous coding means misuse of modifiers. To earn more, providers sometimes enter the wrong modifiers. The more wrongly coded claims may lead to fraud or abuse cases. Outsourcing a medical billing company, can give you access to expert coders that will help to increase the clean claim ratio.
5. Monitor, Improve, Repeat
Carefully observe claims data for trends. For example, observe which payer is putting you in the extra effort? Or any specific mistake is frequently happening? Is any miscoding repeatedly occurring, or is there involvement of a staff member in it? These assessments will help you to identify the problem at the earliest stage.
You can choose different options for claims processing. Outsourcing medical billing firm can help you in getting higher reimbursement. You can spare your resources and use them for patient-centric prospects.
Collection Practices for High-Deductible Plans: 4 Best Practices
The rise in high-deductible plans is altering the types of healthcare expenses Consumers may avoid their billing statements, making patient payments a more significant part of accounts receivable than most medical billing departments.
The longer the time elapses between an encounter and a billing effort, the less likely the practice will collect. Improving collections operations will necessitate instilling a sense of urgency in your employees.
Here are a few ideas to improve your claim ratios:
1. Demand upfront co-pays.
There are no exceptions! Co-pay collection is the most superficial aspect of patient payment to manage. Consequently, it is ridiculous to allow passing. Train your front-desk staff to be vigilant about checking co-pay details at check-in and giving patients as little flexibility as possible regarding upfront payment.
2. Collect Unpaid Balances Before the Next Service.
If a patient has ignored a billed statement for more than ten business days, insist on collecting for the previous service in-office before the next visit. Set firm guidelines with the patient if they insist on paying by mail.
3. Make Use of the Phone
Get patients on the phone sooner than usual, perhaps within 30-60 days of the unpaid visit. Keep in mind that sometimes insured and employed patients are also unwilling to pay. Calling a couple of times can be helpful in collections.
4. Accept a Variety of Payment Methods
The more payment options you provide help you in higher reimbursements. Accept Checks, cash, debit cards, and credit cards.
Three Questions to Ask Before Using Sliding Fee Schedules
A sliding fee schedule allows you to provide discounted services based on a family’s income compared to the Federal Poverty Guidelines. The sliding fee approach is gaining popularity among providers. Developing such a schedule can provide a financial break to low-income and self-pay customers. The said approach allows you to reduce problems associated with unpaid patients.
However, before implementing the sliding-fee model, you should consider how it will affect your practice financially and how you will stay in compliance with applicable regulatory guidelines. Here’s a (non-exhaustive) primer on the considerations.
Are You Able to Afford It?
Every medical practice must balance serving patients (even cash-strapped ones) with earning a sustainable income. You can put your financial stability at risk if you Offer your services at a discount. In the same way, charging too much can turn patients away.
Keep in mind that you have to pay all of your practice’s expenses, including salaries. Break things down to your monthly financial needs and associated per-patient minimums. Determine whether charging less would necessitate a higher patient load than your practice can handle.
Taking billing off the administrative team’s plate allows the most experienced and talented employees to work more closely with patients. As the healthcare system in the United States evolves, deploying team members into care coordination and “patient ally” roles can assist you in complying with value-based government programs and is a prudent financial strategy.
Outsourcing a Medical Billing firm Can Help You Improve Your Clean Claims Ratios
Despite the challenges posed by high-deductible plans, practices can operate successfully in the new landscape. The trend toward greater patient responsibility isn’t going away anytime soon. Doctors should adapt their practice management techniques to be effective.
To effectively adapt their practice management techniques, doctors must first understand what to expect from the new plans and how to proactively mitigate the effects to streamline collections and increase their clean claims ratios.
For many healthcare practices, partnering with an experienced medical billing firm may be the best option for updating their processes and freeing up valuable time and resources dedicated to providing better care. Having decades of experience with various healthcare departments, BellMedex makes it the best one among others. Contact us today for a consultation and to learn how we can help you improve your billing and collections processes.
