The Easiest Way to Evaluate a Medical Billing Service
Why “clean claim rate” is the key to understand your medical billing
This one simple calculation shows you where you stand.
Medical billing can be confusing.
So much so, that many physicians and practice managers can’t tell whether their medical billing service is doing its job effectively.
If this is you, we have some bad news:
You may be losing money.
But we also have good news:
There’s a simple test to evaluate whether your medical billing service is doing its job.
We call it your “clean claim rate.”
Your “clean claim rate” is the single most important measurement of your medical billing - and it only takes a few minutes to calculate.
After reading this article, you will know:
How to calculate your clean claim rate - usually in 5 minutes or less
What to do if your clean claim rate lower than it should be
How your medical billing service can help improve your clean claim rate
Ready? Let’s get started.
What “clean claim rate” is & why it’s important
Simply put, “clean claim rate” is the percentage of office visits that lead to a paid insurance claim.
It’s expressed in the fraction:
Total # insurance claims paid/Total # claims submitted/Total # office visits
The highest possible clean claim rate is 100%.
And you need to remember this:
you shouldn’t accept anything less than 100%.
When your clean claim rate is 100%, every office visit is paid for.
It seems so simple – and in most other industries, it’s obvious. Would you go to a restaurant and walk out on the bill? Would you get on a flight without a ticket? Would you leave a supermarket without paying for your groceries?
Never.
Yet many medical billing services fail this simple test.
And their clients don’t get paid.
How to calculate your clean claim rate in 5 minutes
Your office manager should have easy access to all the information you need to calculate your clean claim rate.
You’ll need to know:
The number of patients you saw over the 30-day period of time 60-90 days before today’s date.
The number of insurance claims submitted for those patients.
The number of those insurance claims that have been paid.
If your medical billing service is doing its job properly, all the numbers above should be the same.
If there’s any discrepancy in those numbers, you have a problem: You’re not getting paid.
You’ll need to talk to your medical billing provider ASAP.
How your medical billing service can help
When our medical billing clients first come to us, they never have a clean claim rate of 100%.
In fact, sometimes 10% or more of their claims are going unpaid.
At ProMedica Partners, we never accept a clean claim rate of less than 100%.
We start by investigating our clients’ office procedures. Industry data show that 85% of issues with insurance claims begin at the provider’s front desk. We work with our clients to discover what exactly is going wrong with their unpaid claims. Then, we create systems and implement procedures to correct the issues.
Not every medical billing provider will do this.
Larger medical billing services generally don’t have the capacity address specific issues for individual clients in this manner. Others simply don’t have the discipline or work ethic to address the underlying issues. Still others may not consider it worthwhile to try to solve difficult issues.
But remember this:
For you, it’s always worthwhile to solve Billing issues and improve your clean claim rate.
Your billing service only takes a small percentage of each claim. The vast majority goes to you.
Every single claim counts.
Is a 100% clean claim rate realistic?
I don’t need to tell you this:
We don’t live in an ideal world.
Sometimes, in real life, problems arise - but when they do, we must identify the source of the problem, correct it, and prevent it from recurring.
The problem with most medical billing providers is that they accept that a certain percentage of claims will go unpaid. Having accepted this, they allow the same errors to keep happening, month after month. If they approached their work with more diligence, these claims would be paid.
However, they don’t.
And their clients lose out.
For our own clients, we don’t always achieve a 100% clean claim rate, but we get as close as we possibly can. We also don’t allow the same errors to persist within our clients’ billing processes. This is the level of service you should expect from your medical billing provider - nothing less.
Next Steps
First, congratulations!
You’ve made the first step towards taking control of your medical billing.
Here’s what you need to do now:
Calculate your clean claim rate ASAP.
If it’s 100%, you’re in good shape!
If you find it’s anything less than 100%, we recommend you talk with your medical billing service to identify what’s going wrong.
If your medical billing service isn’t able to assist you - or if you just want a second opinion - please get in touch with us.
We offer a free, no obligations revenue analysis to help you better understand your current situation.
To get in touch with us & claim you free revenue analysis, click here