Revenue cycle management is critical to operations in any healthcare business. Payment resulting from clean claim submission facilitates optimum collection windows while reducing denials and refund requests from commercial payers.
Treatment centers with internal billing departments often struggle with inherent staffing shortfalls, technology transitions and human error, which can severely impact clean claim rates. Contrary to common misconception, managing these operations internally is not cost effective for most treatment providers. With the right partner, outsourcing billing operations will cost less due to a higher percentage of paid claims and less errors leading to refund requests, medical record audits and Special Investigation Units.
Clean Claims Defined
Clean claims account for 75–85% of those submitted by treatment facilities. Treatment center billing personnel spend excessive time compiling supporting documentation prior to claim payment. Furthermore, facility losses due to inadequately prepared claims can cost hundreds of thousands of dollars in time and resources.
Clean claims are mistake-free, accurate and complete submissions that meet the standards of commercial insurance companies. The following will be evident in a clean claim:
- All healthcare providers were licensed to practice on service provision dates
- Diagnosis codes are provided to support procedure codes for indication of medical necessity
- Coverage includes services billed and dates provided
- All coding is current
- All patient information fields are correctly completed
- Payer, payer ID number and mailing address are correctly provided
- Timely filing deadlines are met
- Required documentation is provided
Justification of Outsourcing Treatment Center Medical Billing
Infinity Behavioral Health Services shares partnerships with more than 200 treatment providers in various regions of the United States. Infinity’s value to our partners exists in personnel expense savings, higher collection rates and less obvious benefits, such as reduced management expense and more effective administrative time appropriation. Infinity Behavioral Health Services provides clean claim submissions.
Outsourcing the frustrating and often redundant processes required to bill insurance releases on-site personnel from daily management of claims. Alleviated stressors are frequently the gaps causing a lower percentage of clean claims by treatment center billing departments. Clients of Infinity Behavioral Health Services average a notable revenue increase through submission of clean claims, proactive follow-up and adaptability in an environment that is constantly evolving.
Treatment center medical billing requires close attention to the following aspects of department administration and management:
- Utilization of concise, well-documented claim correction processes by all treatment center billing staff
- Correction of persistent issues indicated by ongoing payer trend analysis
- Personnel accountability for clean claim rates, including clinical and accounting staff
- Correction time reduction through denial sorting and duty appropriation for efficient reworking
Most treatment center billing departments do not possess these four critical accountabilities, resulting in considerable reduction of clean claim rates.
Infinity Behavioral Health Services has implemented a number of quality assurance measures to ensure that we deliver a higher percentage of clean claims. Clients that partner with Infinity after managing these operations internally can easily identify improvement in these areas, which are crucial to running a health business. Revenue cycles improve while internal woes such as staffing shortfalls and technology difficulties are left behind. For more information about how we can help your business, call us at 800.446.3982.