RCM tip of the day: Improve your clean claim rates

To reduce denials, healthcare organizations should focus on initially submitting clean claims to payers, according to Renee Miller, product manager at Louisville, Ky.-based ZirMed.

Ms. Miller shared the following tip with Becker's Hospital Review.

"Inaccurate claims are often a basic yet avoidable cause of denials, which means denials can be reduced significantly by ensuring claims are clean from the start. The statistics tell the story of the lost revenue. According to the Centers for Medicare and Medicaid Services, only 70 percent of claims are paid the first time they're submitted. The other 30 percent are either denied (20 percent), or lost/ignored (10 percent). Of those claims, 60 percent are never resubmitted, meaning the reimbursement is lost forever. The best way to avoid revenue leakage associated with denied claims is to do a better job of submitting clean claims that can be approved on the first pass. In healthcare today, payers have become hyper vigilant with claims. They are increasingly holding providers accountable for ensuring claims are 100 percent accurate when they are received. To pump up your clean claim rate, start with claims management technology that includes a powerful edit and rules engine and team it up with process improvements and workflows that reduce human error."

Read more tips to reduce claim denials here.

If you would like to share your RCM best practices, please email Kelly Gooch at kgooch@beckershealthcare.com to be featured in the "RCM tip of the day" series.


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