How to Achieve a Better Clean Claims Rate

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Hospitalists have a unique role that’s a part self-employed business owner and part physician. They often face a number of challenges when billing hospitals, which can impact their practice in several ways. Variances in billing protocols, poor communication, and a lack of time to dedicate to administrative tasks are just a few. These issues lead to a poor clean claims rate.

Fortunately, a medical billing app can help hospitalists streamline their workflow, maximize their potential revenue, and improve the claims process. Here are some practical tips to help you achieve a better clean claims rate.

What Is a Clean Claims Rate?

As a hospitalist, it is important to maintain a high clean claims rate, the percentage of claims paid by insurance providers without any errors or denials. Determining what are realistic and transparent clean claim rate benchmarks is a great starting point for better understanding the influencing factors and driving the changes that improve this key metric.

Some of the benefits of a clean claims rate include the following:

Increased Income

A high clean claims rate can help hospitalists increase their income potential by ensuring they’re paid for their services. Denied or underpaid claims can impact a hospitalist’s financial stability and make it more challenging to run a successful practice.

As hospitalists are largely responsible for managing their billing, income, and tax management, getting the best possible results for their efforts is essential.

Enhanced Patient Care

By improving their clean claims rate and core billing metrics, hospitalists can free up more time to focus on patient care rather than billing and administrative tasks. This effort can help improve the quality of care that hospitalists can provide to their patients and improve their reputation with patients and hospital administrators.

Better patient care not only improves overall safety and satisfaction but acts as a strong argument when negotiating rate increases and contracts.

Improved Practice Efficiency

A high clean claims rate can also improve the efficiency of a hospitalist’s practice by reducing the time and resources spent on repetitive and tedious tasks.

Improving administrative tasks’ efficiency can help hospitalists save time and improve their productivity. Better efficiency means taking on a larger caseload without sacrificing the quality of care.

How Hospitalists Can Improve Their Clean Claims Rate

There are several ways that hospitalists can improve their clean claims rate, including selecting the right tools to support their administrative tasks and using performance metrics to track and improve.

Some of the top recommendations to help hospitalists improve their clean claims rate include:

Going Paperless

Paper medical records are outdated and leave the potential for severe gaps in care and security. Electronic health records (EHRs) can help to streamline the documentation process and reduce the risk of errors. EHRs can improve the accuracy of claims and increase their chances of being paid.

According to a JAMA study, EHRs and other data-tracking systems can help reduce billing errors by up to 50%. This improves claim accuracy and ensures sufficient communication between hospitalists and other care providers.

Staying Updated on Billing Codes

Hospitalists need to stay up-to-date on billing codes and guidelines to ensure their claims are accurate and meet the requirements of insurance providers. However, billing coding tends to be a common issue among hospitalists.

Specificity and accuracy are essential with billing codes. Factors like underlying conditions, complexities, comorbidities, and care duration can impact what code should be used. There’s a lot of ambiguity and confusion with some terms, which ends up impacting the hospitalist’s income and clean claim metrics.

Keeping updated and implementing smart technology to ensure your information is relevant is crucial for improving your clean claims rate.

Implementing a Centralized Practice Management System

A centralized practice management system can help hospitalists better manage their billing and administrative tasks, including claims processing and reimbursement. This can help improve the billing process’s efficiency and increase the chances of claims being paid.

Centralized practice management systems and “billing apps” are often used interchangeably. Keep this in mind when exploring options to improve your hospitalist practice.

What to Look for in Medical Billing Apps

Medical billing apps for iPhones and Android devices can provide many benefits for hospitalists, including improved efficiency, accuracy, financial management, and patient care. By choosing an app that meets the specific needs of their practice and provides robust security and support, hospitalists can effectively leverage technology to enhance their billing process.

When choosing a medical billing app, hospitalists should consider the following factors:

Specialty Specificity

Hospitalists in specialized fields will face nuanced challenges with coding and billing. The selected app should be tailored to the specific needs of hospitalists, including the codes and billing guidelines that are relevant to their practice.

Provider Reputation

Hospitalists should research the reputation of the app’s developer to ensure they’re trustworthy and have a track record of success. Asking for recommendations, testimonials, and referrals from other hospitalists can help validate service providers. Exploring a free tour or demo can also increase confidence when choosing an app.

HIPAA Compliance

The app should comply with HIPAA regulations to ensure the privacy and security of patient data. This consideration is paramount when choosing a billing app.

Ease of Use

Hospitalists are already juggling a lot when it comes to administrative tasks. As such, the billing app should be user-friendly and easy to navigate.

Support Options

In addition to evaluating the overall provider reputation, consider the app’s ongoing customer support and training options. These features lessen the learning curve and ensure hospitalists can use the app effectively.

Centralization

The app should provide a centralized location for all relevant patient information and billing data, such as access to patient progress notes, EHRs, and analytics.

AI Features

Consider a billing app with AI features, such as smart code search capabilities and in-depth analytics, to enhance the efficiency and accuracy of the billing process.

Final Thoughts

Overall, maintaining a high clean claims rate is important for hospitalists to increase revenue, improve patient care, and enhance the efficiency of their practice. By implementing strategies to improve their clean claims rate and investing in a centralized billing app, hospitalists can effectively manage their billing process and improve healthcare delivery.