Each state has passed a Clean Claim Law. The level of benefit these laws provide to medical practices and facilities starts on the low end with states such as South Dakota that provide little more than a slap on the insurance company's wrist to states such as Texas which levy substantial financial penalties on tardy payers.
Clean Claim laws can be a powerful medical billing tool because they are built upon the concept that insurance companies have a responsibility to quickly adjudicate clean claims. The typical law provides 30 days for a payer to process a clean electronic claim. To properly benefit from Clean Claim laws a medical billing company or medical practice must be capable of reliably and systematically keeping track of:
1. To which insurance companies does your state's clean claim law apply (some payers are exempt);
2. The date your practice initially submits each medical claim;
3. Any events that legitimately give the payer more time to process the claim (for instance, a request for additional information);
4. When your practice has taken actions in response to payer requests;
5. The date when you received the payer's final adjudication decision.
Planning and constructing the monitoring system can be difficult, but it can have a significant impact on how quickly your claims are paid cleanly. Aggressive users of clean claim laws have actually received calls from payers assuring them that their claims will be process quickly and requesting that complaints be held to give the payer a chance to prove itself.
If you would like to better understand the benefits of implementing a Clean Claim Law tracking system before investing the time and energy into the design and implementation of the system, then run a pilot. Identify a payer that is consistently in violation of the Clean Claim Law. Select 30 to 50 claims from this payer and manually track all of the items outlined above. Once you have some violations, file a report following your state's guidelines. This process will allow you to better understand what will be required to make such a system a permanent part of your medical billing and see the potential benefit to your practice.
Copyright 2006 by Carl Mays II - 15359
Clean Claim laws can be a powerful medical billing tool because they are built upon the concept that insurance companies have a responsibility to quickly adjudicate clean claims. The typical law provides 30 days for a payer to process a clean electronic claim. To properly benefit from Clean Claim laws a medical billing company or medical practice must be capable of reliably and systematically keeping track of:
1. To which insurance companies does your state's clean claim law apply (some payers are exempt);
2. The date your practice initially submits each medical claim;
3. Any events that legitimately give the payer more time to process the claim (for instance, a request for additional information);
4. When your practice has taken actions in response to payer requests;
5. The date when you received the payer's final adjudication decision.
Planning and constructing the monitoring system can be difficult, but it can have a significant impact on how quickly your claims are paid cleanly. Aggressive users of clean claim laws have actually received calls from payers assuring them that their claims will be process quickly and requesting that complaints be held to give the payer a chance to prove itself.
If you would like to better understand the benefits of implementing a Clean Claim Law tracking system before investing the time and energy into the design and implementation of the system, then run a pilot. Identify a payer that is consistently in violation of the Clean Claim Law. Select 30 to 50 claims from this payer and manually track all of the items outlined above. Once you have some violations, file a report following your state's guidelines. This process will allow you to better understand what will be required to make such a system a permanent part of your medical billing and see the potential benefit to your practice.
Copyright 2006 by Carl Mays II - 15359
About the Author:
Carl Mays II, CEO of ClaimCare Medical Billing Services, has spent over 14 years improving the financial performance of his clients. To learn more about what to look for in Healthcare Billing Services see his other articles.
