Revenue Cycle Key Performance Indicators Part 2

In part 1 of Revenue Cycle Key Performance Indicators (KPIs), we discussed the importance of monitoring average days in accounts receivable (AR). In part 2, we are addressing clean claim submission rate and what that means as a KPI and tracking the fiscal well-being of your healthcare billing revenue cycle.

The clean claim submission rate is a key performance indicator (KPI) that measures the percentage of claims submitted to insurance payers that are accepted and processed without any errors or rejections. A low clean claim submission rate indicates that an unacceptable portion of claims is being denied or delayed by payers on the first submission, which results in payments taking longer to occur.

How to Calculate Clean Claim Submission Rate

Clean Claim Submission Rate = (Number of Clean Claims Submitted / Total Number of Claims Submitted) x 100

Here are some strategies to help improve the clean claim submission rate:

  • Accurate and Detailed Documentation
    Ensure that all patient encounters are accurately documented with the necessary information, including diagnosis codes, procedure codes and supporting documentation.

  • Resources and Continuing Education for Coding Practices
    Engage in regular training and updates for coding staff on coding guidelines and best practices to ensure accurate coding and reduce claim errors.

  • Stay Up-To-Date with Payer Requirements
    Keep track of specific requirements and guidelines of different insurance payers to ensure claims are submitted correctly.

  • Monitor and Analyze Claim Rejections
    Regularly review claim rejection reports for recurring patterns and trends.  Based on findings, implement procedures to improve the process.

  • Consider Outsourcing
    A dedicated medical billing organization has proven processes in place to consistently avoid billing errors for a high clean claim rate. In addition, they constantly study their craft, staying up-to-date on newly issued billing practice requirements. Utilizing a medical billing organization is a win-win – they help increase your bottom line, and your practice can focus on patient care and practice growth.

Improving your clean claim submission rate leads to more efficient claims processing, quicker reimbursement and improved revenue cycle management.

David Swiercz