How can you use clean claim rate to improve revenue cycle management?

1 What is CCR and how to calculate it

CCR is calculated by dividing the number of clean claims by the total number of claims submitted in a given period. For example, if you submitted 1,000 claims in a month and 800 of them were clean, your CCR would be 80%. You can calculate your CCR for different payers, providers, or services to identify areas of improvement or best practices. You can also track your CCR over time to monitor your progress and trends.

3 How to benchmark your CCR against industry standards

Benchmarking your CCR against industry standards can help you set realistic and achievable goals, identify gaps and opportunities, and measure your performance against your peers and competitors. According to the Healthcare Financial Management Association (HFMA), the average CCR for hospitals is 75%, while the best practice is 90% or higher. For physician practices, the average CCR is 85%, while the best practice is 95% or higher. You can use these benchmarks as a reference point, but you should also consider your own factors, such as payer mix, specialty, volume, and contract terms.

4 How to improve your CCR with best practices

In order to improve your CCR, it is necessary to take a comprehensive and continuous approach that involves all the stakeholders and steps in the revenue cycle. To help boost your CCR, you should consider implementing a robust software system that automates and streamlines your claim generation, submission, and tracking processes. Additionally, you should establish clear policies and procedures for coding, documentation, and verification, as well as provide regular training and feedback to your staff. You should also perform pre-claim audits and edits to check for errors or discrepancies before submitting the claims to the payers. Furthermore, you should monitor your claim status and denials, following up promptly with the payers to resolve any issues or appeals. Finally, analyzing your CCR data and reports to identify patterns and areas of improvement is essential. This will enable you to implement corrective actions and preventive measures.

5 How to leverage your CCR for contract negotiation and optimization

Your CCR can also be a valuable tool for negotiating and optimizing your contracts with your payers. A high CCR can demonstrate your value and credibility as a provider, and give you leverage to negotiate better rates, terms, and incentives. A low CCR can indicate areas of improvement or alignment, and help you optimize your contract performance and compliance. You can use your CCR data and reports to support your claims and requests, and to communicate your expectations and goals with your payers.