AquinaFebruary 7, 2019

Everything You Ever Wanted to Know About Clean Claims

Everything You Ever Wanted to Know About Clean Claims

“Clean Claims” — a very buzzy term in healthcare right now. So what is a clean claim? What’s all the excitement about? And why?

Accuracy matters.

A clean claim is simply one that is submitted with every “i” dotted and every “t” crossed. This means it’s been checked over for potential errors and sent for reimbursement with all of the necessary documentation. While this may seem like a no-brainer, approximately 80% of all medical claims are submitted with some type of error, usually billing. Other issues include missing explanations of benefits (EOBs), or incomplete/incorrect identifying or insurance information from the patient.

This, of course, causes the claim to be rejected by the insurer, which hurts both the patient (who is waiting to find out what their financial responsibility is) and the provider (who needs that reimbursement to keep revenue cycling smoothly through their practice).

Four tips for ensuring clean claims.

  1. The number one most important factor in submitting a clean claim is documentation, documentation and more documentation. Detailed records of every patient encounter are the only way medical coders can create error-free claims, and the more information and detail you can provide, the cleaner and more accurate the claims they submit will be.
  2. Always review denied claims. Always. Given the number of errors we just described, it’s worth it to take a second look at denied claims. Sometimes errors are easier to spot the second time around. And don’t let them sit in a file somewhere, collecting dust; set parameters around this part of the claims cycle for specialists to review denied claims within a given timeframe, and make sure it happens.
  3. Make sure your team knows your payers (and their requirements/policies/processes) better than they know themselves. Anyone who has ever had to work with a health insurance company knows they each have their quirks, differences and/or idiosyncrasies. There’s no way to avoid these, so it’s always best to, if not embrace them, at least accept and know how best to handle them. If claims are sent for reimbursement with these “quirks” in mind, it increases the odds of them coming back approved.
  4. Don’t be afraid of technology. While many people revel in the general speed and efficiency that technology can bring to the table, there are still more than a few folks who shy away. Given how complicated some software can be, this shouldn’t be surprising. When otherwise-excellent team members aren’t completely on board with the technology being utilized, it is often worth it to put the time into training them up appropriately in order to meet them where they are. Financially and operationally, it’s almost always better to invest in a great employee than to hire someone new, and the more comfortable they are with the software, the fewer mistakes they will ultimately make.

In a high-pressure environment of patient care, there is simply little to no room for mistakes that can hurt a practice’s finances. Clean claims not only expedite reimbursement but also decrease the back-end costs associated with working denials.

Via Keeps Revenue Flowing Smoothly

Even the cleanest, most well-documented claim can often take weeks, if not months, to process. In the meantime, the practice loses out on revenue. This is why many companies have chosen to integrate Aquina’s Via solution into their claims processing system. Via allows insurance claim reimbursements to be expedited, ultimately contributing to the smooth, continuous flow of revenue that makes for a health practice bottom line. With integration already in place with leading EHR providers such as athenahealth and Kareo, getting started is easy. Contact Aquina Health today and find out how.