Improving your clean claim rate: 5 areas to focus on

In a recent Hayes Management Consulting blog, Dion Giordano provides five areas to focus on when improving your clean claim rate.

With today’s ever-increasing squeeze on healthcare organizations’ bottom lines, the quality and performance of a billing department is vital to its operating margin. What’s more, the billing department’s clean claim rate is a critical factor to help achieve budgeted operating margins.

A clean claim is a claim that was accurately processed and reimbursed the first time it was submitted to the payer, without error, rejection, and manual intervention. Industry best practice for first pass clean claim rate is 90% or above which can be understandably difficult considering how many claims an organization processes everyday but not impossible if the billing department is optimized.

Here are some areas of your billing department you should examine when wanting to improve your organization’s clean claim rate. These will not only make your processes more efficient but also ensure your organization hits the best practice percentages that ultimately help your bottom line.

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