There's a renewed focus among independent medical practices to reduce insurance claims rejections and denials, and to achieve a higher rate of clean claims submission. One way to take control of your clean claims rate is to create a Rejection Prevention Team. This may include representatives from the front desk, clinical staff, billing staff and management. This helps create buy-in at each step in the patient visit cycle and helps eliminate the “blame game.”
The Rejection Prevention Team becomes even more important if the billing process is outsourced to a third party billing company. Having open communication between the staff in the office and the billing company staff is critical to maintaining a solid clean claims rate. The billing company should provide feedback on frequent rejections and denials and how the practice compares to other practices they work with.
In order for your Rejection Prevention Team to be effective, you need some tools to track rejections and categorize them based on where in the visit cycle the error was made so that you can correct the process through additional training or improved protocols.
Claim Rejection Log
A simple spreadsheet that includes the date of rejection, date of service, claim number, patient account number, CPT code, charge amount, payer, and rejection or denial reason is a good start. It is helpful to group your rejections into a few major categories, such as: Registration, Eligibility, Coding, and Providers (both rendering and referring).
Clean Claims Rate Tracking Tool
This tool can be as simple as recording the date, type (internal, clearinghouse or payer), total number of claims submitted, and the number of rejected claims. This allows you to calculate your clean claims rate and track it over time to monitor trends.
Clean Claims Guide
This guide provides a comprehensive review of the most common preventable rejections and denials, and offers tips and resources to address the issues causing those throughout the patient visit cycle. Decreasing the time and cost of getting claims paid and increasing the net collections rate results in more money collected for the practice. Who doesn’t want more money for less effort?