Answer to Question #156041 in Management for Shelby Kinder

Question

How do clean claims impact health care organizations? What are the risks to the billing process if claims are not clean? Provide examples.

Answer 1

Impact of Claims on Healthcare Organizations

Claims can be termed as clean if they are complete and do not contain any errors. In cases where these aspects are not met, they often result in delayed payments or losses. From a healthcare perspective, a clean claim identifies the healthcare officer, facility, provider, affiliation status, and any other identification number. It should also provide patient details and their plans, including dates and locations in which they received the services. Other factors should be considered, including the legibility of the individual, the necessity of the medication, the type of service rendered, and the method through which the service was rendered (MB&CC, 2021). However, in a scenario where the claims are dirty, the healthcare institution may suffer significantly. For instance, it may lead to inefficiencies during operations because of the duplication of records and thus translate to billing inaccuracies. Also, the healthcare institution may incur huge losses since the bills will reflect duplicated records, which could then be denied by insurance providers. Such cases arise if a patient, for instance, is treated using another patient’s medical records.

Reference

MB&CC. (, 2021). Potential Billing Problems and Returned Claims. MedicalBillingandCoding.org. Retrieved 16 January 2021, from https://www.medicalbillingandcoding.org/potential-billing-problems-returned-claims/.