Filter Dirty Data From Your RCM System for Clean Claims

Posted in Data Analytics, Revenue Cycle Management (RCM)

Dirty data is a barbed thorn in the side of many healthcare organizations. Inaccurate or incomplete data can create an array of problems during the revenue cycle management (RCM) process.

To avoid these issues, providers must purge dirty data from their RCM systems. This may sound easy enough, but unfortunately it’s often easier said than done.

There are several tactics that can reduce inaccurate and incomplete data, and thus minimize the number of claim denials related to dirty data. First, however, it’s paramount to understand why clean claims are critical to a healthy revenue cycle.

What is a Clean Claim?

According to the American Academy of Professional Coders, a clean claim is simply “a claim free of any errors.” The AAPC was founded to provide certification to medical coders; it is also focused on elevating “the standards of medical coding.”

To improve clean claim rates, the AAPC recommends double-checking every case before it is submitted. The organization advises that this can be performed either manually or with the assistance of RCM technology. By rechecking claims on the front end, a healthcare provider can drastically reduce denial rates.

And the more clean claims a provider files, the faster the provider will be paid for services it’s already conducted. This income flow is instrumental to serving new patients and generating new revenue opportunities.

Clean Claims: An Essential Healthcare KPI

Most healthcare providers, like most businesses, leverage key performance indicators (KPIs) to measure their overall performance. That said, many do not actively monitor the difference between their clean claims and their initial claim denials.

A recent survey found that less than 80% of hospitals track these two metrics and measure their difference. Yet this approach provides insights into how many claims are paid upon the first submission.

If a healthcare provider has a high clean claim rate but also experiences a high frequency of initial denials, it may be time to re-evaluate the revenue cycle. Upon doing so, the provider may find an RCM system clogged with dirty data.

Inaccurate or incomplete information creates discrepancies during the medical coding and billing processes. This, in turn, can lead to an unusually high rate of denials, even if the majority of submitted claims are considered clean and are ultimately approved.

Strategies for Clean Claims

There are several ways to maintain clean claims and avoid denials. Multiple tactics are recommended for optimal results.

If inaccurate or incomplete data makes it past one layer of protection, it will likely be detected during the next phase of the revenue cycle before it’s submitted to the payer. Following are some strategies that can filter dirty data during the revenue cycle:

Stop Dirty Data Before it Starts

Ideally, dirty data would be prevented from entering a healthcare provider’s RCM platform. Those responsible for RCM would clean up any data submitted to the electronic medical records (EMR) system before uploading the information to the RCM service.

This process can be complicated at times, as some RCM services give providers the ability to input medical coding and billing data into EMRs. The experience levels of the staff inputting this data can vary, and in some cases these team members are also focused on other tasks such as patient care.

Those responsible for this type of data entry should be well-versed in its best practices, especially medical coding requirements.

Clean Your Data Upfront

The sooner data-entry errors can be identified and corrected, the better. A proactive approach is critical to resolving billing issues.

If inaccurate charges can be corrected before a claim is submitted to the payer, the total number of claim denials can be reduced. Resubmitting a denied claim or filing an appeal with a provider is more time-consuming than submitting an initial claim. This problem can be avoided by ensuring clean data upfront.

Eliminate Data Fragmentation

Data fragmentation occurs when a healthcare provider uses incompatible software from multiple vendors. Since these programs cannot effectively communicate, not all data is available on every platform. This data fragmentation can wreak havoc when it’s not reconciled, resulting in escalating claim denials and a prolonged revenue cycle.

One solution for data fragmentation is an end-to-end RCM service that encompasses all facets of the revenue cycle. It prevents tasking oft-overburdened staff with data entry on different platforms; instead, vital data is readily accessible from one source with interconnected components.

If an error is detected, the fully integrated RCM system can revise it across its networked modules. This feature allows healthcare providers to efficiently update their databases and improve their claim-acceptance rates.

Create Custom Rules to Address Common Errors

End-to-end RCM technology also allows providers to deploy and automate custom rules that identify and flag frequent coding or billing errors so users can review the claims in question.

By doing so, healthcare coders can spend less time reviewing claims and more time on other tasks. Automated checks for common mistakes further streamline the revenue cycle, diminish claim denials, and free team members to focus on other duties that impact patient experience.

Results-Driven Healthcare RCM

GeBBS Healthcare Solutions provides comprehensive RCM services that cover everything from scheduling and eligibility verification to medical coding to accounts-receivable management to credit resolution.

Acclaimed for its advanced RCM and health information management (HIM) systems, GeBBS is a healthcare technology leader with an extensive record of success helping healthcare organizations filter out dirty data, increase claim-approval rates, and maximize profitability. Our medical coding and healthcare billing experts understand industry best practices, and are knowledgeable of all Medicaid state plans, managed care plans, third-party insurance, and government programs, as well as Medicare billing.

Request your consultation today to learn how our truly end-to-end RCM solution can optimize every phase of your revenue cycle.

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