Clinics Achieve 95% Clean Claim Rate by Using Automation and These 5 Strategies Now.

Running a clinic involves more than just the patients; there is the operational component that requires attention. 

I’m sure most of you have experienced the frustration of claim denials or the longer wait for payments, and the reality is that most people are in the same boat.  

Roughly 20% of medical claims processes face challenges with rejections and denials, and the majority are due to small, easily avoidable mistakes (Source: Journal of AHIMA).  

Now, the great news is that, with the integration of automation and some policies, clinics like yours are achieving a 95% clean claim rate. 

This means you no longer need to fret about such things and will have more money coming in.  

In this blog, I will show you 5 simple and effective strategies that will allow you to achieve the results you desire.

Key Takeaways:

• How Clean Claims is affected by its strategy.
• These checks help to cut down rejected applications by 25%.
• Claims Scrubbing Tools find coding/billing mistakes before the claim is submitted.
• RPA in Prior Authorization reduces time spent waiting for approval by 50%.
• EHRs that are used together help ensure the accuracy of patient data.
• Before actual denials can occur, Predictive Analytics predicts them.

1. Getting Eligible for Automatic Insurance

You can start with clear claims only when your data is clean, and the initial defense is using automation to check a person’s eligibility.

The best clinics automatically check insurance to verify it is good, active, and covers the needed procedure before making an appointment. 

As part of the main front-end process, one of the steps the clinics ensure is that most eligibility-based declines are eliminated.

Benefits:

You get an instant confirmation that you meet the requirements, decreased amount of billing problems, and greater happiness among patients.

2. AI-Assisted Automated Claim Scrubbing

Revenue cycle management needs a scrubber that catches everything, because that’s the strongest offense.

Such software automatically reviews all claims for correct codes, proper patient data, and anything payers may require, and that saves time by only dealing with strong claims.

This important step on its own can claim denials dropped by 30%, billers now save a lot of time thanks to automated checks, and pay medical claims processing more quickly.

3. RPA is Being Used in the Area of Prior Authorization.

Problems with prior authorization delays? Now, clinics often put the bots in charge of making these calls.”

Often, getting prior authorizations delays the delivery of healthcare ( healthcare call center ) and payment. 

RPA automates how clinics manage sending and monitoring requests for prior authorization, and they can complete these steps on their own by logging into portals.

Results include quicker acceptance by the bank, having less to do for staff, and fewer denied claims because of insufficient authorization.

4. EHR and Billing can Work Together Without Complications.

When systems are not connected, companies don’t get all the revenue they should, and the closing of gaps is what integration does.

Today’s clinics have systems that join EHR and billing, keeping patient data, medical codes, and invoicing information up to date in real time. 

This reason explains why there is no copying of data, manual form filling, transcription, or any other type of error that could cause the rejection of a claim.

During this approach, leading clinics rely on healthcare call center workers to manage information, respond to patient inquiries.

They help in any parts of the revenue cycle process where help is needed, and make it easier for patients, and also help prepare accurate information for claims.

5. Solutions for Denial Prevention

Smart clinics today are using data to predict problems and prevent them, rather than only being able to identify a problem.

When billing systems save denial trends, tools for forecasting can study past information and predict future problems. 

They send live warnings when a possible error is found, call out claims that are too risky, and provide solutions before the claim is sent.

This way of acting ahead of time reduces resubmissions, lifts the percentage of cases settled during the first review, and improves the way revenue is projected.

Revenue cycle automation is one of the reasons that enables the top clinics, which enjoy a 95 percent clean claim rate, to automate and not simply rely on luck. 

Maximizing efficiency, reducing denials, and raising their revenues are achieved by these clinics by relying on eligibility verification, claim scrubbing, RPA in authorizations, EHR integration, and predictive analytics.

If you plan to participate, bringing on smart tools and hiring capable healthcare support companies will get you started on successful claims.

Conclusion!!

A clean claim positively affects revenue, keeps the team less stressed, and helps the focus remain where it is mostly needed–on the patients. 

Applying the right blend of strategy and automation helps clinics achieve up to 95% clean claim rates and minimizes errors. 

The adjustments you can make do not just cater to larger practices–you can begin on a microscale with the intention of achieving macro results. 

With the tips we have provided, it goes a long way, and now the power is in your hands to determine how smoothly you can make your billing process function.