How ACU-Serve Improves Clean Claim Rate in Medical Billing

One crucial metric in HME/DME revenue cycle management is the clean claim rate. A high figure means your system contains accurate patient and payer information, which makes for a reliable billing process.

As more HME/DME providers seek to reduce administrative burdens and optimize processes, improving clean claims in medical billing becomes increasingly vital. Let’s discuss how clean claims impact HME/DME organizations and what you can do to boost yours.

What Is a Clean Claim in Medical Billing?

A clean claim is one that’s free from errors, inaccuracies, and other mistakes. The payer can process and accept it from the first pass without requesting supporting documentation, verification, or rework, reducing payment delays from resubmissions.

The clean claim rate is a key performance indicator that HME/DME providers track in medical billing and claims. The industry benchmark is at least 90%—nine of every ten claims submitted must be error-free to ensure a smooth revenue cycle and claims management operation.

The Role of ACU-Serve in Increasing Clean Claim Rates

ACU-Insight, ACU-Serve’s proprietary analytics software, is a game changer in ensuring clean claims in medical billing. Here are its key benefits.

• Eliminates manual intervention in claims, from intake to cash posting. Fewer touchpoints mean fewer errors, ultimately resulting in cleaner claims.
• Tracks and reports every employee interaction with a claim, which could pinpoint the most efficient and cost-effective way to bill specific claims to specific payers.
• Reduces staffing and training costs by automating patient data collection, validation, and processing to speed up the process.

Let’s discuss further how ACU-Serve and ACU-Insight can strengthen your claim scrubbing process in the long term.

Preventing Common Clean Claim Errors

Promptly addressing dirty claims minimizes delays from rejected claims and allows for more timely payments. 

What common errors can prevent clean claims?

• Validating patient and payer data at intake.
• Using intelligent workflows to flag missing authorizations.
• Scrubbing claims against payer-specific edits.
• Monitoring compliance requirements across Medicare, Medicaid, and commercial payers.

This reduces rework and ensures claims get paid on the first pass.

Submitting Claims on Time

Payers typically allow claim submissions for up to a year after the covered service is rendered. That said, missing deadlines is still a common reason payers deny claims. These backlogs accumulate over time, slowing your revenue cycle.

ACU-Insight helps you stay on top of claim deadlines through the following features:

• Intelligent queueing automatically prioritizes claims that are approaching their filing deadlines.
• Masterful workflows streamline the entire claims submission process to prevent delays and eliminate bottlenecks.

Analyzing Claim and Payment Trends

Integrating analytics-based insights into billing services can help HME/DME providers spot areas for improvement.

ACU-Insight makes these findings visible. It offers information and metrics that provide a bird’s eye view of your entire financial health and operations by doing the following:

• Tracking claim denial rates: This figure measures your claim accuracy and the effectiveness of your clean claim submission processes.
• Identifying day sales outstanding (DSO) by payer or payer group: This metric improves your cash flow and payment timelines.
• Monthly review of denials, invoice touches, and payment activity: It offers insights into your claim performance and payer trends.

Benefits of a High Clean Claim Rate

Every HME/DME company should aim for a high clean claim rate to reap the following benefits:

• Get paid on the first pass and, subsequently, reduce initial claim denials.
• Limit write-offs by reducing the amount of accounts receivable that need to be nullified.
• Lower collection costs through automation, which reduces administrative burden and spending.
• Reduce audit risk since clean claims meet regulatory and payer requirements.
• Elevate staff work because they can focus less on administrative work and more on what matters most—high-quality patient care.
• Enhance patient experience by reducing billing issues and enabling smoother interactions.

Proven Results with ACU-Serve

Our data-driven approach and industry expertise deliver measurable results, ensuring HME/DME providers achieve outstanding clean claim rates.

• >77% Clean Claim Rate: Our streamlined processes ensure claims are submitted accurately the first time, reducing denials and delays.
• <15% of A/R Over 90 Days: We accelerate reimbursements and minimize aging accounts, improving cash flow and financial predictability.
• 93% Collection Rate: Our expert revenue cycle management maximizes reimbursements, ensuring providers collect the revenue they are owed.

Takeaway

Achieving a high clean claim rate is essential to building a stronger, more predictable revenue cycle. With ACU-Serve’s global team approach and ACU-Insight technology, providers gain both the expertise and the tools to submit cleaner claims, reduce denials, and accelerate reimbursements.

If you’re ready to improve your clean claim rate and strengthen your revenue cycle, book a meeting with ACU-Serve today.Book a meeting with us today to learn more about our end-to-end RCM solutions!