Percentage of Clean Claims on First Submission

Percentage of Clean Claims on First Submission is a key metric in healthcare revenue cycle management that measures the percentage of claims that are submitted and processed without any errors or rejections on the first attempt. This metric is important because it directly impacts the speed and efficiency of the revenue cycle process, as well as the overall financial health of the healthcare organization. A high percentage of clean claims on first submission indicates that the organization has effective processes in place for verifying patient eligibility, coding claims accurately, and submitting claims in a timely manner. On the other hand, a low percentage of clean claims on first submission can lead to delays in payment, increased administrative costs, and decreased revenue. Therefore, monitoring and improving this metric is critical for healthcare organizations to optimize their revenue cycle performance.

Percentage of Clean Claims on First Submission is calculated by dividing the total number of claims that are processed and paid on the first submission by the total number of claims submitted. The resulting percentage indicates the efficiency of the revenue cycle management process in terms of submitting accurate and complete claims that are accepted and paid by the insurance company on the first attempt. This metric is important because it directly impacts the cash flow of the healthcare organization and reduces the need for additional resources to follow up on denied or rejected claims. To calculate this metric, the healthcare organization needs to track the number of claims submitted and the number of claims that are processed and paid on the first submission. The formula for calculating the Percentage of Clean Claims on First Submission is:

Clean Claims on First Submission = (Total Number of Claims Processed and Paid on First Submission / Total Number of Claims Submitted) x 100%

For example, if a healthcare organization submitted 1,000 claims and 800 of them were processed and paid on the first submission, the Percentage of Clean Claims on First Submission would be:

Clean Claims on First Submission = (800 / 1,000) x 100% = 80%

This means that 80% of the claims submitted by the healthcare organization were processed and paid on the first submission, indicating a high level of efficiency in the revenue cycle management process.

Best practices to improve Percentage of Clean Claims on First Submission are:

1. Accurate Patient Information: Ensure that all patient information is accurate and up-to-date, including demographic information, insurance details, and medical history. This will help to avoid errors and reduce the likelihood of claim denials.

2. Timely Claim Submission: Submit claims as soon as possible after the patient visit to avoid delays and reduce the risk of claim denials. This will also help to ensure that the claim is processed quickly and accurately.

3. Proper Coding: Ensure that all medical codes are accurate and up-to-date, and that they are properly linked to the patient's diagnosis and treatment. This will help to avoid errors and reduce the likelihood of claim denials.

4. Clear Documentation: Ensure that all medical documentation is clear, concise, and complete, and that it supports the medical codes and diagnosis. This will help to avoid errors and reduce the likelihood of claim denials.

5. Regular Training and Education: Provide regular training and education to staff on proper coding, documentation, and claim submission processes. This will help to ensure that staff are up-to-date on best practices and can identify and address any issues that may arise.

6. Use of Technology: Utilize technology such as electronic health records (EHRs) and revenue cycle management (RCM) software to streamline processes and reduce errors. This will help to improve the accuracy and efficiency of claim submission and reduce the likelihood of claim denials.

By implementing these best practices, healthcare organizations can improve their Percentage of Clean Claims on First Submission, reduce claim denials, and improve their revenue cycle management overall.

The industry standard benchmark for Percentage of Clean Claims on First Submission is typically set at 95%. This means that healthcare organizations should aim to have at least 95% of their claims processed without any errors or rejections on the first attempt.

However, it is important to note that this benchmark may vary depending on the specific healthcare organization and the types of claims being processed. For example, certain specialties or procedures may have a higher rate of claim rejections, which may impact the overall benchmark for clean claims on first submission.

Overall, tracking and improving the Percentage of Clean Claims on First Submission is crucial for healthcare organizations to optimize their revenue cycle management and ensure timely and accurate reimbursement for services provided.

Revenue cycle software can significantly improve the Percentage of Clean Claims on First Submission metric by automating the claims submission process and reducing errors. With the help of advanced algorithms and machine learning, revenue cycle software can identify and correct errors in real-time, ensuring that claims are submitted accurately and on time. This reduces the need for manual intervention and minimizes the risk of claim denials or rejections.

Moreover, revenue cycle software can also help healthcare organizations track and monitor their claims submission process, providing real-time visibility into the status of each claim. This allows organizations to identify bottlenecks and inefficiencies in their revenue cycle and take corrective action to improve their processes.

If you're looking to improve your Percentage of Clean Claims on First Submission metric, then it's time to consider implementing revenue cycle software. MD Clarity's revenue cycle software is a powerful tool that can help you streamline your claims submission process, reduce errors, and improve your overall revenue cycle performance. Book a demo today to see firsthand how MD Clarity's revenue cycle software can help you achieve your revenue cycle goals.