Claim Resubmission Rate

Claim Resubmission Rate is a key metric in healthcare revenue cycle management that measures the percentage of claims that need to be resubmitted to payers due to errors or denials. This metric is important because it directly impacts the revenue cycle and cash flow of healthcare organizations. A high claim resubmission rate can lead to delayed payments, increased administrative costs, and decreased revenue. By tracking this metric, healthcare organizations can identify areas for improvement in their claims submission process, such as staff training or technology upgrades, to reduce errors and denials and improve their overall revenue cycle performance.

Claim Resubmission Rate is calculated by dividing the total number of claims that require resubmission by the total number of claims submitted during a specific period of time, typically a month or a quarter. The resulting percentage represents the proportion of claims that were not accepted on the first submission and required additional work to be processed. This metric is important because it can indicate issues with claim accuracy, coding, or documentation that may be causing delays in reimbursement and negatively impacting revenue cycle performance.

By tracking the Claim Resubmission Rate over time, healthcare organizations can identify trends and areas for improvement in their billing processes and take corrective action to reduce the number of claims that require resubmission.

Best practices to improve Claim Resubmission Rate are:

1. Identify the root cause of claim denials: Analyze the reasons for claim denials and identify the root cause. This will help in addressing the issue and reducing the number of claim denials.

2. Implement a robust denial management process: Develop a comprehensive denial management process that includes tracking, analyzing, and resolving denied claims. This process should involve all stakeholders, including providers, billing staff, and payers.

3. Train staff on coding and billing guidelines: Ensure that your billing staff is well-trained on coding and billing guidelines. This will help in reducing errors and improving the accuracy of claims submitted.

4. Use technology to automate the claims process: Implement technology solutions that can automate the claims process, including claim submission, tracking, and resubmission. This will help in reducing the time and effort required to manage claims.

5. Monitor and measure claim resubmission rate: Regularly monitor and measure your claim resubmission rate to identify areas for improvement. Use this data to develop strategies to reduce the number of claims that require resubmission.

6. Improve communication with payers: Establish open communication channels with payers to understand their requirements and guidelines. This will help in submitting accurate claims and reducing the number of denials.

7. Conduct regular audits: Conduct regular audits of your billing process to identify areas for improvement. This will help in identifying and addressing issues before they become a problem.By implementing these best practices, healthcare organizations can improve their claim resubmission rate, reduce the number of denied claims, and improve their revenue cycle management process.

The industry standard benchmark for Claim Resubmission Rate is typically around 5-10%.This means that healthcare organizations should aim to keep their Claim Resubmission Rate below 10% to ensure that they are effectively managing their revenue cycle and minimizing the risk of lost revenue. A higher Claim Resubmission Rate can indicate issues with claim accuracy, coding errors, or other issues that may be causing claims to be denied or rejected.

To improve their Claim Resubmission Rate, healthcare organizations should focus on identifying and addressing the root causes of claim denials and rejections. This may involve improving coding accuracy, streamlining billing processes, and implementing effective denial management strategies.

By monitoring and managing their Claim Resubmission Rate, healthcare organizations can ensure that they are maximizing their revenue and minimizing the risk of lost revenue due to claim denials and rejections.

Revenue cycle software can significantly improve the Claim Resubmission Rate metric by automating the claims management process. With the help of advanced software, healthcare providers can easily identify and correct errors in claims before submitting them to insurance companies. This reduces the likelihood of claims being rejected or denied, which in turn reduces the need for resubmissions.

Additionally, revenue cycle software can help providers track the status of claims in real-time, allowing them to quickly identify and address any issues that may arise. This level of visibility and control over the claims process can significantly reduce the need for resubmissions and improve the overall efficiency of the revenue cycle.

If you're interested in seeing firsthand how revenue cycle software can improve your Claim Resubmission Rate metric, we invite you to book a demo with MD Clarity. Our software is designed to streamline the revenue cycle process and improve key metrics like Claim Resubmission Rate. Contact us today to learn more!