The Importance of Clean Claim Submission

A medical practice’s failure to release clean claims – claims that pass the clearinghouse, arrive at the payer and are paid upon first review – results in significant, adverse consequences to the practice’s revenue and cash flow. Industry research shows that medical practices regularly submit a material portion of their claims in a manner that results in denials upon arrival at the clearinghouse or payer. By incorporating sound coding principles, proper modifier usage and claim scrubbing mechanics, a medical practice’s claim submission can approach a nearly-error free rate. Claim scrubbing reduces claim errors, rejections and denials such as those listed below, which may commonly be seen on an explanation of benefits or electronic remittance advice:

  • CPT code is invalid for this date of service
  • Procedure 1 is missing a diagnosis code
  • Diagnosis code is invalid
  • Member not effective on this date of service
  • Member ID invalid
  • Inpatient claim missing an admission date

To reduce these errors, it is important to validate all billable codes each October-December when the new/updated CPT and ICD-9/ICD-10 codes are released. In addition, understanding changes to the codes along with payer policy guidelines will ensure proper coding and decreased delay in payment.
If the claim leaves your practice management system “clean” upon first submission, you will decrease the amount of time it takes for you to receive your reimbursement from the payer. For additional information on coding and claim submission, please contact us so we can help you!