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How to increase your claim rate and why does it matters?

The “claim rate” is a vital element in RCM (Revenue Cycle Management) that shows how well you are managing your revenue cycle. To improve the overall revenue cycle, the first thing that a practice should focus on is its clean claim rate, as claim rejections can be costly. The “clean claim rate” of a practice refers to the percentage of claims submitted that are error-free, complete with all necessary information, and submitted within the specified time frame. Every time a claim is rejected, it impacts your revenue cycle and reduces the overall income that your practice generates. Rejected claims increase workload and disrupt an already lengthy and complicated revenue cycle process. With claim payments and denials being the top concerns of the provider, it can distract the practice from providing a focus on other equally important functions. The process of rework and resubmission of denied claims can take up a lot of time and effort on your part and can disturb the smooth functioning of your practice. Therefore, it becomes important that you get the maximum number of claims accepted on the first try itself.

So, how can the claim rate be increased?  Here are some tips:

Accuracy Over Speed

Collect accurate patient data because any inaccuracy could result in the claim being denied. This is the crucial and most important aspect of developing clean claims. The information that you have collected should always be accurate and precise. Most practices, in their hurry to submit claims, often overlook the need for cross checking information collected. Presenting accurate claims should always be of prime importance. Make sure you have all the necessary information on patients, including their medical data. Even a tiny error in the claim, such as a spelling mistake can lead to its denial, so make sure to go through the claims multiple times to avoid any such errors. 

Elaborate Eligibility and Benefits Verification

Most claim denials occur because of errors in eligibility checking, while every successful insurance payment is largely dependent on successful eligibility and benefits verification. Proper eligibility verification provides the practice with a clear view of a patient’s insurance coverage, benefits and payment obligations so that they can submit clean claims without any mistakes. It is important to go through patient information and insurance coverage details before providing any services. It is also important to do proper follow-up on this information to make sure that any changes in the patient information are updated regularly.

Staying up-to-date with insurance rules as well as patient information

The insurance payment rules and regulations undergo changes frequently. Therefore it is very important to stay up to date with these changing policies so as to produce clean claims. Any inconsistency in it can lead to the denial of claims. It is equally important to keep track of the patient information and data so that any changes in it are updated as soon as possible. Depending on the rules and regulations, even a small error or tiny missing piece of information can lead to a lot of hassle. Don’t shy away from contacting the patients or insurance providers if any additional information is needed or any doubts need to be cleared. 

Partnering with an RCM service provider

With an RCM service provider by your side, you can focus your attention on more important tasks such as patient care and the growth of your practice without any worries about the claim being denied. They help you by ensuring that the claims are submitted error-free and with all the necessary information. They pay attention and stay up-to-date with the changing insurance regulations without you having to worry about it. They provide expert professional services that help you submit clean claims, thus reducing the number of denied claims and speeding up your revenue cycle.

Managing denied claims

Denied claims are not just a loss in revenue but also an amazing opportunity to learn from your mistakes so as to prevent it from happening again. Proper analysis of denied claims can provide you with answers to why claim denials happen and how they can be reduced. It could be your best chance to improve the clean claim rate. Analyzing claim denials helps you in identifying the most recurring reasons for claim denials, which should be addressed as fast as possible to avoid further denials. By tracking, analyzing and measuring denied claims, practices can work on improving their clean claim rate.

Why does it matter?

The high clean claim rates show the quality of your practice. It shows the quality of data collections as well as the effort and time that goes into error correction in your practice. It also helps in tracking the efficiency of your claim submission process. Increasing the clean claim rate helps in reducing the time and effort required for the insurance payment process. An increase in clean claim rates implies a decrease in time, effort and expense involved in insurance payment. It entails less work, reduced cost and fewer days in accounts receivable(AR), which ultimately leads to faster payment. It ensures faster and more efficient payments so that no time is wasted on delayed or denied claims. Denied claims can create a lot of difficulties, including loss in revenue, time and effort but with the submission of clean claims, these difficulties can be avoided. Not just that, but submission of inaccurate claims can even lead to legal trouble, as submission of too many inaccurate claims can lead to your practice being flagged for potential fraud and abuse. The clean claim rate of your practice can directly impact your overall revenue. Therefore, it is important to maintain a high claim rate for the financial success of your practice. 


The clean claim rate may not completely eliminate claim denials, but it certainly helps to reduce the number of denied claims to a significant extent. Clean claim rate can hugely impact the success of your practice. It can be detrimental to the increase in the overall revenue of a practice. Therefore, it is important to maintain at least an average clean claim rate for the smooth working of a practice. Considering an RCM service provider could be your perfect solution for maintaining a high clean claim rate, but remember to choose your service provider carefully as it can make the whole difference. 

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