The law’s main premise is that a payer must reply to a valid claim within a certain amount of time (usually around 30 days for electronic claims).

In order to efficiently use the clean claim rule, your medical billing process must have a tracking system that flags:

• Which insurance firms are covered by your state’s clean claim statute (some are exempt)?
• The date on which your clinic submits each medical claim for the first time;
• Events that bring the clean claim clock to a halt (e.g., an information request from the payer),
• When your practice has responded to payer requests by taking action;
• The date on which you received the final adjudication decision from the payer.

The prospect of carefully tracking all of this data may seem intimidating, but with the right system architecture, it is both achievable and desirable. Your claims will pay faster after you file a few Clean Claim law violation reports. I’ve witnessed cases when payers have contacted solely to reassure the practitioner that claims will be processed swiftly.

Running a trial on a payer that frequently takes more than 30 days to adjudicate claims is one method to quickly get started using the clean claim law. Find a small number of significant claims for this payer that have been open for more than 30 days and run a test with them. This will enable you to understand the foundations of how to file, monitor, and view the results of complaints.

Tips for Getting Your Medical Practice to Have a 95% Clean Claims Rate

How can your medical practice attain a clean claims rate of 95%? Despite the fact that this may appear to be a tall goal, there are several medical billing tactics your medical practice may apply to help increase your clean claims rate – and your entire revenue cycle management!

Keep patient records up to date.

There’s a lot of patient information that can change—and change quickly—from contact information to insurance carriers and more. Patients must check or update their current information before getting treatment, as faulty patient data is a leading source of denied claims. To reduce delays, use exact documentation to help check patient information ahead of time, and have patients update their paperwork at every visit (or even sooner with automated reminders).

Prior to the date of service, double-check your eligibility.

Patients that come to your office on a regular basis are known as established patients. They’re also the patients who your employees might presume haven’t had any recent insurance changes. Most denied claims, however, are generally the result of outdated established patient insurance information. Collecting and confirming every patient’s primary, secondary, and even tertiary insurance at least five days before their scheduled service is one step toward a 95 percent clean claims rate.

It’s also vital to double-check any in- or out-of-network benefits, copays, or deductibles.

Keep in mind the deadlines for filing insurance claims.

In most cases, filing a claim necessitates submitting it within a specific time frame. Any claim submitted outside of the window will result in a higher number of refused claims.

 If you want your practice to have a near-perfect clean claim ratio, one of the best ways to do so is to pay attention to claim deadlines and handle any concerns with patient coverage prior to their date of service so the claim is not submitted late. Aim for authorization between three and five days prior to service as a best practice.

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 of them opt to have their billing handled by a third party. Ultimately, WWS contributes to a smooth, continuous flow of revenue that benefits the bottom line of health practices. Contact WWS today to learn more.

Here are some of the five simple effective ways to make your billing efficiency and thereby to speed up the AR collections at your practice.

Eligibility Verification of insurance coverage:

This is more necessary to ensure that when the Durable Medical Equipment services are billed, patient’s insurance coverage has been verified and the services, equipment are covered by the insurance or Medicare. If not, this could lead to delays in payment and re submissions which could prove costly in the long run.

Stringent Coding: 

Coders need to be well versed with the coding, especially when it comes to DME services and the equipment used. The minor error in just a transposed number in a claim code, or even entering an outdated modifier, can lead to a rejected or denied claim, leading to a loss of timely reimbursement.

Effective Claims Management process: 

Follow ups are very essential for an effective Billing workflow and AR collection. It is known that many Durable Medical Equipment services lose an average of about seven percent of their reimbursements due to rejections and or denials and no follow ups of the claims. This ineffective claims management process is costly to the RCM of any medical practice.

Trained In-house or Outsourced expertise:

No matter what you go for in – house or outsource, workers employed in handling the claims submission need to be knowledgeable about the different rules and requirements for claims submissions.

Improved Technology: 

Automation in electronic Health records, enhanced Practice Management systems, improve monitoring and enable alert systems go a long way in making the claims process a much more effective and efficient system to improve the AR collections.

Conclusion

The above five point’s need not all is simultaneously be made effective as it could be a costly overhead. But, with planning and possibly even outsourcing just the billing and or the claims management process, your DME services can be made to be more efficient and thereby a much more effective AR collections process can be implemented. The bottom line is to see that your reimbursements keep flowing in to provide for a healthy and profitable Revenue Cycle Management process.

Schedule a free live demo http://localhost/main-site-update/live-demo/ to know how to improve your Durable Medical Equipment billing efficiency and to speed up the AR Collections.