Electronic Claim Submission Rate is a key metric in healthcare revenue cycle management that measures the percentage of claims that are submitted electronically to insurance payers. This metric is important because electronic claim submission is faster, more accurate, and less expensive than paper-based submission. A high electronic claim submission rate indicates that the healthcare organization is efficient in its billing processes and is likely to receive payment faster. It also reduces the risk of errors and denials, which can lead to delays in payment and increased administrative costs. To calculate the electronic claim submission rate, divide the number of claims submitted electronically by the total number of claims submitted.
Electronic Claim Submission Rate is calculated by dividing the total number of electronic claims submitted by the total number of claims submitted, and then multiplying the result by 100 to get a percentage.
The formula for calculating Electronic Claim Submission Rate is:
Electronic Claim Submission Rate = (Total number of electronic claims submitted / Total number of claims submitted) x 100
For example, if a healthcare organization submitted a total of 1,000 claims in a given period, and 800 of those claims were submitted electronically, the Electronic Claim Submission Rate would be:
Electronic Claim Submission Rate = (800 / 1,000) x 100 = 80%
This means that 80% of the claims submitted by the organization were submitted electronically. A higher Electronic Claim Submission Rate indicates that the organization is using electronic claims submission more frequently, which can lead to faster payment processing and reduced administrative costs.
Best practices to improve Electronic Claim Submission Rate are:
1. Verify Patient Information: Ensure that all patient information is accurate and up-to-date before submitting the claim. This includes verifying the patient's name, address, insurance information, and policy number.
2. Use Clearinghouses: Utilize a clearinghouse to submit electronic claims. Clearinghouses can help identify errors in claims before they are submitted, reducing the number of rejected claims.
3. Implement Claim Scrubbing: Implement claim scrubbing software to identify and correct errors in claims before they are submitted. This can help reduce the number of rejected claims and improve the overall submission rate.
4. Train Staff: Train staff on the importance of accurate and timely claim submission. Provide ongoing training to ensure that staff members are up-to-date on the latest billing and coding guidelines.
5. Monitor Performance: Monitor the electronic claim submission rate regularly to identify areas for improvement. Use data analytics to track trends and identify patterns that may be impacting the submission rate.
6. Address Rejected Claims: Address rejected claims promptly to ensure that they are resubmitted in a timely manner. This can help improve the overall submission rate and reduce the number of denied claims.
7. Utilize Technology: Utilize technology to automate the claim submission process. This can help reduce errors and improve the overall submission rate.
By implementing these best practices, healthcare organizations can improve their electronic claim submission rate, reduce the number of rejected claims, and ultimately improve their revenue cycle management.
The benchmark for Electronic Claim Submission Rate is an industry standard metric used to measure the percentage of claims that are submitted electronically by a healthcare provider. This metric is an important indicator of the efficiency and effectiveness of a provider's revenue cycle management process.
The industry standard benchmark for Electronic Claim Submission Rate is 95%. This means that healthcare providers should aim to submit at least 95% of their claims electronically. This benchmark is based on the fact that electronic claim submission is faster, more accurate, and less expensive than paper-based submission.
Providers who fall below the benchmark may experience delays in payment, increased administrative costs, and decreased revenue. On the other hand, providers who exceed the benchmark may experience faster payment, reduced administrative costs, and increased revenue.
To improve their Electronic Claim Submission Rate, providers can implement electronic health record (EHR) systems, use clearinghouses to submit claims, and train staff on proper coding and billing practices. By achieving the industry standard benchmark for Electronic Claim Submission Rate, providers can improve their revenue cycle management process and ultimately provide better care to their patients.
Revenue cycle software can significantly improve the Electronic Claim Submission Rate metric by automating the claim submission process. With the help of revenue cycle software, healthcare providers can submit claims electronically, which eliminates the need for manual data entry and reduces the chances of errors. The software can also automatically check for errors and missing information before submitting the claim, which further improves the accuracy of the claim submission process.
Moreover, revenue cycle software can help providers track the status of their claims in real-time, allowing them to identify and resolve any issues quickly. This can significantly reduce the time it takes to receive payment for services rendered, improving the overall revenue cycle management process.If you're interested in seeing firsthand how revenue cycle software can improve your Electronic Claim Submission Rate metric, we invite you to book a demo with MD Clarity. Our revenue cycle software is designed to streamline the revenue cycle management process, improve efficiency, and increase revenue. Contact us today to schedule your demo!