AKASA, a healthcare revenue cycle management, released survey results demonstrating that measuring the difference between clean claims and initial denials rates has become standard practice for revenue cycle operations teams at health systems across the country.
Revenue cycle automation experts at AKASA recommend health systems instead focus on first pass payments as the main key performance indicator. This measures the true outcome of claim preparation practices and accuracy.
Clean claims refer to claims that are considered error-free and expected to be ready for processing and payment by payors or insurance companies and organizations. Initial denial rates refer to the percentage of claims submitted to payors that are initially denied for any number of reasons. In theory, if 90% of an organization's claims are "clean", then 90% of their claims should be paid on the first pass or the first time they are submitted to a payor.
Commissioned by AKASA, the survey fielded responses from more than 350 chief financial officers and revenue cycle leaders at hospitals and health systems across the United States through the Healthcare Financial Management Association's (HFMA) Pulse Survey program between December 17, 2020 and February 5, 2021. The national survey was designed to assess the adoption of automation in revenue cycle operations at hospitals and health systems across the U.S.