The RCxRules Blog

How to Achieve Clean Claims with Less Effort

How to Achieve Clean Claims with Less Effort

What is a clean claim?

According to AAPC, a clean claim is defined as “a claim free of any errors.” Submitting these the first time around is essential to an efficient workflow. If you want to improve your clean claim rate with less effort, check out these tips.

Create a centralized knowledge bank with all coding and billing review criteria.

RCM directors, coders, and billers know their business better than anyone. But in many cases, their expertise resides entirely in their heads—it’s rarely documented for new or existing team members to leverage. There are millions of billing and coding criteria that need to be referenced to ensure clean claims, including industry-standard rules such as general ICD-10-CM and CPT guidelines, specialty-specific rules, and information that is unique to your practice and payers. Constantly changing billing and coding requirements make training and a consistent claim review process challenging. Staff turnover further complicates the process. Having one location to host all your organization’s billing and coding knowledge is an efficient way to keep data updated and ensure clean claims.

Identify and address common billing and coding errors with custom rules.

Are there specific billing or coding errors your team is consistently finding that need correction? If so, you’re not alone. Our experience has shown that 50% of claims have a coding or billing error that needs correction. Many organizations recognize common billing, coding, and denial trends but do not have a tool in place to proactively manage them. With technology, you can implement custom rules to review billing and coding data and automatically flag errors for coder review. Coders are a valuable and expensive resource. Using automation to aid in their claim review process ensures they are spending their valuable time only on those claims needing review.

Stay tuned for our next revenue cycle focused blog to learn more about custom rules.

Set up a 15-minute meeting to learn more about taking your clean claim rate from good to great.


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