3 Tips to Promoting a Lean Claims Process

The leanest process in medical billing includes clean claims. It may seem counter to lean process principles to add steps to your current billing processes but reducing waste while promoting proactive and less reactive actions is a key element to a lean process. Here are 3 tips for submitting clean claims.

Tip 1: Check eligibility and benefits ahead of visits. Collect patient’s responsibility at the time of service. 

This will help you avoid eligibility surprises and delayed patient payments. Both errors require costly time and effort on the back-end work to resolve. 

Tip 2: ‘Scrub’ charts prior to claim submission. 

Implement an internal review process that will prevent the top denial reasons: 

• Incorrect or missing modifier
• Bundled services
• Referral or prior authorization not obtained
• ICD-10 code unspecified
• Inappropriate 1CD-10 to CPT link
• Does not support medical necessity per payer
• Payer has a policy regarding the use of Eye Visit codes

As the saying goes, “An ounce of prevention is worth a pound of cure,” taking the time before the claim is submitted to review for these common denials is part of a lean process by avoiding the wasted time and effort on resubmitting claims. Who is responsible for “scrubbing” the claims in your practice?

Tip 3: Learn from your and others’ billing mistakes through constructive communication. 

We all make mistakes, but repeatedly making the same mistake is a choice. Make the choice to learn from any claim submission errors. Create a work environment where honestly admitting when errors occur is encouraged so you can work to prevent them.