Six Best Practices for Coding and Billing Clean Claims 

Increase in the number of denials 

Health practices are struggling to manage an increase in the number of denials for coding and billing clean claims and underpaid claims as denial rates have continued to soar. With 33% of hospitals now reporting average claim denial rates of 10% or higher, the provider community is forced to spend nearly $8.6 billion a year trying to appeal and overturn denied claims.

Needless to say, this has a detrimental impact on your bottom line. With so much at stake, it has become even more important for you to code expertly and accurately. Fortunately, high-performing revenue cycle partners can provide reassurance through their expertise at coding and billing clean claims. 

The significance of first pass coding and billing clean claims 

Although back-end denial management is an integral part of the revenue cycle management process (RCM) process, the first pass resolution rate (FPRR) indicates how streamlined the process is.  

Below are six best practices for submitting coding and billing clean claims the very first time. 

1. Maintain and update patient information – Patient data is subject to volatility and even a minor inconsistency can lead to denials. Make sure to update basic information like addresses, phone numbers, employer, and insurance plan, during every patient encounter. 

1. Verify eligibility and authorization prior to the date of service – These two steps are imperative for submitting clean claims, yet a frequent cause for denials. As intensive tasks that need to be meticulously executed, these tasks when performed in-house leave a lot to be desired. As you deal with staffing issues and the need for continuous training, it becomes challenging to stay on top of changing guidelines and handling documentation aspects of the job. Needless to say, amid escalating labor shortages, trusting a healthcare revenue cycle management (RCM) partner is a smart way for your practice to avoid front-end denials.   

2. Provide detailed clinical documentation – The processing of coding and billing clean claims is reliant on the precise documentation of the services provided so they can be properly coded and billed. The emerging trend of payers challenging claims on the grounds of medical necessity makes it even more critical to ensure thorough and accurate clinical documentation. This can be the difference between getting a claim passed or rejected.   

3. Pay close attention to dates – Failure to file claims as per the specified payer timelines can cause an otherwise coding and billing clean claims to be rejected. Regular reviews should include a review of submission deadlines to help organize work queues. 

4. Double check modifiers – It is extremely important to apply coding modifiers accurately and to the correct procedure. The National Correct Coding Initiative has useful tools for providers to ensure that they are using the correct codes. 

5. Follow payer-specific coding guidelines – Different payers can have different coding guidelines that are specific and required. Be sure to both understand and comply with them to ensure compatibility. 

6. Claim scrubbing – Claim scrubbing should be a mandatory step in any submission process, since it helps detect and eliminate any errors in billing codes. You can either get the best RCM partner to do it for you or leverage technology and utilize analytics at your disposal. 

While there are so many causes for the claims denial, most denials are preventable. It’s important for you to proactively put fixes in place and learn to get to the root cause of the denial. 

Are you looking for an RCM partner? EMPClaims has the expertise and experience to ensure clean claims and timely reimbursements for your practice. You can Contact us today to get more details on various coding and billing clean claims practices.