When it comes to your revenue cycle, few metrics are as important—or as overlooked—as your clean claim rate. A high clean claim rate means your claims are submitted accurately the first time, resulting in faster payments and fewer denials. A low rate, on the other hand, can signal inefficiencies, coding errors, or documentation gaps that are costing your practice money.
Let’s take a closer look at why clean claim rates matter and how Outsource Receivables Inc. (ORI) helps healthcare practices improve them for stronger financial results.
What Is a Clean Claim Rate?
A clean claim is one that is submitted to the payer without errors and processed on the first attempt without needing corrections or resubmissions. The clean claim rate refers to the percentage of claims that are accepted and paid the first time they’re submitted.
The industry standard for a good clean claim rate is typically above 90 percent. At ORI, we aim for 95 percent or higher.
Why Does It Matter?
Every denied or delayed claim represents time, money, and resources spent on reworking something that could have been done right the first time. Here’s how low clean claim rates affect your practice:
- Delayed Payments: Denied claims can take weeks or even months to resolve.
- Increased Administrative Burden: Staff must spend time reviewing, correcting, and resubmitting claims.
- Lost Revenue: Some denials may never be reworked or appealed, leading to write-offs.
- Reduced Cash Flow Predictability: Inconsistent collections can affect your ability to forecast and budget effectively.
Common Reasons for Dirty Claims
Claims that are denied or returned for correction usually include errors such as:
- Incomplete or incorrect patient information
- Incorrect insurance details
- Missing or invalid CPT/ICD-10 codes
- Lack of medical necessity documentation
- Incorrect modifiers
- Non-compliance with payer-specific rules
These issues can often be avoided with proper verification, documentation, and technology support.
How ORI Helps Improve Clean Claim Rates
At ORI, clean claims are a priority. Our process is designed to catch and correct issues before claims are ever submitted. Here’s how we do it:
- Pre-submission Scrubbing: Every claim is reviewed for errors, missing data, and compliance with payer rules.
- Specialty-Specific Coding Expertise: Our certified coders understand the nuances of specialty procedures and documentation.
- Eligibility Verification: We confirm insurance coverage before the patient is seen to reduce eligibility-related rejections.
- Real-Time Claim Tracking: Clients can view claims as they move through the system with custom dashboards via MedBizCloud.
- Fast Denial Follow-Up: If a denial does happen, our team works it within 48 hours, so your revenue isn’t left hanging.
Clean Claims = Cleaner Revenue Cycle
Improving your clean claim rate has a ripple effect across your entire practice. With fewer denials and faster payments, you can:
- Improve cash flow
- Reduce time spent on administrative tasks
- Minimize write-offs
- Improve patient satisfaction with fewer billing issues
Final Thoughts
Clean claim rates are a direct reflection of billing efficiency and accuracy. If your practice struggles with denials, delayed payments, or inconsistent cash flow, improving this metric could have a major impact on your bottom line.
At Outsource Receivables Inc., we help practices submit claims right the first time—and we back our results with guaranteed performance metrics. Ready to take control of your revenue cycle? Contact us for a free assessment and find out how much cleaner your claims (and your collections) could be.