Clean Claims: A New Year's Resolution You Can Keep

Why This Topic Matters

Denied claims can slow reimbursement, increase rework, and strain coding and billing teams. The article is relevant to organizations looking for broad operational approaches to improve coding accuracy and reduce denial-related revenue loss.

Article Sections

1. Why do claims get denied?

   Introduces common reasons claims are denied, including data issues, encounter documentation problems, and coding inaccuracies. It also discusses broader patterns such as duplicate billing and miscoding.

2. Overcoding

   Explains how excessive or improperly grouped reporting can contribute to denials and compliance concerns. The section distinguishes among related overreporting patterns at a high level.

3. Undercoding

   Describes the opposite pattern of reporting less than what was performed or supported. The section focuses on why this can still harm reimbursement and denial rates.

4. How Denied Claims Negatively Affect the Revenue Cycle

   Outlines the operational and financial effects of denials on cash flow, key performance measures, forecasting, and staff workload. It also discusses how denials can create backlogs and reinforce error cycles.

5. Benefits of Clean Claims

   Summarizes the workflow and financial advantages of reducing denials and improving coding quality. It also highlights how cleaner claims can free staff time and support more accurate review processes.

6. Five Resolutions RCM Professionals Can Make to Ensure Clean Claims

   Presents a set of broad operational priorities for revenue cycle teams, including training, deadline management, burnout reduction, auditing, and technology adoption.

7. Prioritize staff education.

   Focuses on the role of ongoing training and awareness of industry and payer updates. The section connects education with fewer repeated errors and better coding consistency.

8. Don't miss claims deadlines.

   Discusses filing timelines and the challenge of managing payer-specific deadlines. It emphasizes the operational value of organized deadline tracking and workflow support.

9. Reduce medical coding and billing staff burnout.

   Addresses staffing pressure, workload strain, and the effect of burnout on errors. The section frames workforce support as part of denial reduction.

10. Audit your medical coding.

    Covers the use of internal auditing to understand coding performance and identify recurring issues. It presents auditing as a way to establish baseline visibility and track improvement.

11. Utilize autonomous medical coding technology.

    Describes the potential role of AI-based coding technology in routine coding, auditing, and workflow support. The section also discusses general categories of coding elements that automation may help manage.

12. Don't Let The Implementation Process Deter You

    Explains general considerations for implementing autonomous coding technology and integrating it with existing systems. The section focuses on adoption, data needs, and workflow fit.

13. Make 2023 The Year of Clean Claims

    Concludes with a broad call to improve coding quality and adopt operational changes that support cleaner claims. It reinforces the article's emphasis on revenue cycle efficiency and automation.