How to Submit Clean Medical Claims for Your Practice

How to keep claims clean

Nothing is more frustrating in medical billing than a claim that is denied for a clerical error. Mistakes such as these add unnecessary time to the process and can delay reimbursement, longer than one might expect. Improving the percentage of clean claims (claims without errors) will increase the timeliness of your revenue flow, and decrease your overall accounts receivable amount and time in aging. Here are three simple ways to keep your claims clean:

Tip #1: Verify Patient Demographic

Gather information correctly from the start. One way to improve the number of clean claims in your practice is to develop a process that helps capture accurate demographic information for medical billing. This can start when a patient first calls to make an appointment. Many of these errors stem from things as simple as a misspelled name or incorrect date of birth. Always confirm the address is correct so that statements are not returned.

Tip #2: Watch the ID Card

When submitting a claim, make sure the patient’s name matches what is indicated on their insurance card. Insurance carriers can and will deny the claim for something as simple as a missing middle initial. This is especially true for Medicare claims.

Gather accurate patient information

It is important to note that many patients change insurance carriers at the start of a new year. However, even when a patient’s carrier remains the same, the start of a new year can mean coverage changes for their current plan. In some cases, the actual ID number or the claims mailing address may change. Therefore, it is always worthwhile to ask for copies of the patient’s most up-to-date insurance card each time they come in for a visit.

Tip #3: Know Where to Send the Claim First

This may seem obvious, but it can actually be a complicated issue to solve. When a patient comes in with multiple insurance cards, it is not always clear-cut which insurance is primary. This can lead to a coordination of benefits denial which can be easily avoided with prior knowledge.

For example, a patient of Medicare age may come in with a Medicare card as well as a card for their Medicare replacement plan. In most cases, a Medicare card will automatically be used as the patient’s primary. However, by definition a Medicare replacement plan should be used instead of the standard Medicare policy. Mistakes like this are common when patients and staff are not properly educated on the differences.

Establishing a system of insurance verification will help prevent claims from getting caught up in denials such as coordination of benefits.

Clean Claims Pay Quickly!

Any piece of information that is incorrect will affect the payer’s processing of the claim and could result in denials; rejections, or partial payment.  Also, “dirty” claims will increase the cost associated with obtaining the correct reimbursement.  Staff will need to follow-up on why claims have not been processed or paid and this takes time and money to do.

Consistently verifying all information before a claim is submitted will increase the number of clean claims that your practice submits.  This results in faster, correct reimbursement and will save time and money from following up, correcting, and resubmitting claims.

Disclaimer: The materials contained on this website are provided for informational purposes only and do not constitute legal or other professional advice on any subject matter. Advanced Medical Practice Management does not accept any responsibility for any loss which may arise from reliance on information contained on this site.