revenue cycle benchmark

How to Get a Clean Claim the First Time, Every Time

Ensuring that a claim is clean the first time it is submitted can save your ASC a lot of time, and potentially money. It may take 30 days or longer to get a denial response back, and then you’ll have to start the billing process over again. Clean claims will reduce your AR days and increase your cash flow.

Here are some foolproof ways to get you a clean claim every time:

  • It is imperative to provide front-office staff with training and regular feedback to prevent unnecessary errors. The road to a clean claim starts with the front-office staff getting the right demographics, verifying insurance, and generally ensuring there aren’t any administrative errors going into the claim.
  • Doctors must take great care in dictating information correctly in terms of what procedures were done. Coders must then properly research and identify the right diagnosis and procedure codes before claims are submitted. Attention to detail is key here – one incorrect or imprecise code can result in a denial.
  • Billers must properly append the correct modifier to the procedure code if applicable, submit the claim to the right insurer, and confirm that the procedure is billable for that specific payer. It can be tempting for a biller to go on autopilot and make assumptions about what is and is not billable, but that can lead to avoidable errors.
  • Utilize RCM technologies to provide feedback on denials for each set of users within the claim submittal process. Then build custom edits within the clearinghouse that will kick a claim back before it is submitted if it does not meet certain standards. This will ensure you don’t spend precious time in the denial process and risk not getting paid.