Clean Claim in Medical Billing:

Medical billing is a complex process that requires a high level of accuracy, attention to detail, and adherence to strict regulations. One of the most critical aspects of medical billing is submitting clean claims. A Clean Claim in Medical Billing is a claim that is free of errors and meets all the necessary requirements for payment. In this blog post, we will explore the definition of clean claims, the importance of submitting them, and some tips for ensuring that your claims are clean.

What is a Clean Claim In Medical Billing?

A clean claim in medical billing is a claim that has no errors or omissions and meets all the requirements for payment. A clean claim must include all the necessary information such as patient information, diagnosis codes, procedure codes, and billing codes. Additionally, it must be submitted within the required timeframe and must comply with all the rules and regulations set by insurance companies, government programs, and other payers.

Components of a Clean Claim:

A clean claim should contain the following components:

Patient Information: The patient’s name, date of birth, and insurance information must be accurate and up-to-date. Any errors or discrepancies in this information can lead to claim denials or delays.

Provider Information: The provider’s name, address, and NPI number should be included in the claim. This information is essential for identifying the provider and ensuring that the claim is paid to the correct entity.

Diagnosis Codes: Diagnosis codes are used to identify the medical condition for which the patient is being treated. These codes must be accurate and up-to-date to avoid claim denials or delays.

Procedure Codes: Procedure codes are used to identify the medical procedures or services provided to the patient. These codes must be accurate and up-to-date to ensure that the claim is paid for the correct services.

Billing Codes: Billing codes are used to identify the charges for the medical services provided. These codes must be accurate and up-to-date to ensure that the correct charges are billed to the payer.

Benefits of Submitting Clean Claims:

Submitting clean claim in medical billing has several benefits, including:

Faster Payment: Clean claims are processed quickly, leading to faster payments for the provider.

Reduced Denials: Clean claims are less likely to be denied, resulting in fewer claim resubmissions and reduced administrative costs.

Improved Cash Flow: Submitting clean claims improves cash flow by reducing the time between claim submission and payment.

Increased Patient Satisfaction: Clean claims lead to accurate billing, which can increase patient satisfaction and trust in the provider.

Here are some tips for submitting clean claims:

Use Accurate and Up-to-Date Patient Information: Ensure that the patient’s name, date of birth, and insurance information are accurate and up-to-date.

Use Accurate and Up-to-Date Diagnosis Codes: Ensure that the diagnosis codes are accurate and up-to-date to avoid claim denials or delays.

Use Accurate and Up-to-Date Procedure Codes: Ensure that the procedure codes are accurate and up-to-date to avoid claim denials or delays.

Use Accurate and Up-to-Date Billing Codes: Ensure that the billing codes are accurate and up-to-date to ensure that the correct charges are billed to the payer.

Follow Payer Guidelines: Follow the guidelines set by the payer to ensure that the claim meets all the necessary requirements for payment.

Double Check Everything: Before submitting the claim, double-check all the information to ensure that it is accurate and complete.


Submitting Clean Claim in Medical Billing is crucial for the financial success of a medical practice. Clean claims are claims that have no errors or omissions and meet all the necessary requirements for payment. They include accurate patient and provider information, diagnosis codes, procedure codes, and billing codes. By submitting clean claims, providers can benefit from faster payment, reduced denials, improved cash flow, and increased patient satisfaction. To ensure that claims are clean, providers should follow payer guidelines, use accurate and up-to-date information, and double-check everything before submitting the claim. By following these tips, providers can streamline their medical billing processes and improve their bottom line.


What are the benefits of outsourcing medical billing?

As the healthcare industry continues to evolve and become more complex, medical practices and facilities are constantly seeking ways to improve their financial performance and reduce costs. One way to achieve this is through outsourcing medical billing services to experienced and reputable companies. Outsourcing Medical Billing Services can provide numerous financial benefits to medical practices, such as improved revenue cycle management, reduced operational costs, and increased cash flow. This article will explore the various financial benefits of outsourcing medical billing services, and how it can help medical practices thrive in today’s challenging healthcare environment.

Why Outsourcing Medical Billing Services Can Improve Patient Care?

In today’s fast-paced healthcare industry, medical providers are under constant pressure to deliver quality care to patients while also managing the administrative aspects of running a medical practice. One area where this challenge is particularly acute is medical billing. Billing errors, denied claims, and delayed payments can lead to significant financial losses for medical practices, as well as patient dissatisfaction and even legal issues. This is where benefits of outsourcing medical billing services can make a significant impact on improving patient care.

By outsourcing medical billing, medical providers can focus on what they do best – providing high-quality care to patients. Outsourcing companies specialize in handling all aspects of the billing process, from claims submission and payment posting to follow-up and appeals. This frees up medical providers to spend more time with patients and improve the overall quality of care.

Top 5 Reasons Healthcare Providers Should Consider Outsourcing Medical Billing

As the healthcare industry becomes more complex, medical billing has become a significant challenge for healthcare providers. Outsourcing medical billing services has emerged as a popular solution to this problem. Outsourcing medical billing offers healthcare providers numerous benefits, and here are the top 5 reasons why healthcare providers should consider outsourcing medical billing:

Reduced administrative burden:

Outsourcing medical billing can significantly reduce the administrative burden on healthcare providers. Medical billing is a complex process that requires expertise and resources, and outsourcing can free up medical staff to focus on patient care and other critical tasks.

Increased revenue:

Outsourcing medical billing can help healthcare providers improve their revenue cycle management by reducing billing errors, accelerating claims processing, and improving collection rates. This can result in increased revenue and improved cash flow, which can help healthcare providers invest in better patient care.

Access to expertise:

Outsourcing medical billing can provide healthcare providers with access to specialized expertise. Medical billing outsourcing companies typically have experienced professionals who are well-versed in the latest billing regulations and coding requirements. This expertise can significantly reduce the likelihood of errors or delays in the billing process, resulting in faster payment processing and fewer denied claims.

Cost savings:

Outsourcing medical billing can help healthcare providers save money by reducing overhead costs associated with in-house billing operations. By outsourcing, healthcare providers can avoid the costs of hiring and training staff, purchasing billing software, and managing billing operations.

Improved patient satisfaction:

Outsourcing medical billing can lead to improved patient satisfaction. Faster claims processing and fewer errors mean patients receive more accurate billing information and timely communication about their healthcare costs. This can result in greater trust and confidence in healthcare providers, leading to increased patient loyalty and retention.

In conclusion, outsourcing medical billing services can provide healthcare providers with numerous benefits, including reduced administrative burden, increased revenue, access to expertise, cost savings, and improved patient satisfaction. As the healthcare industry continues to evolve, outsourcing medical billing has become an essential tool for healthcare providers looking to improve their operations and provide better patient care.


Medical billing is an important aspect of the healthcare system that involves the process of submitting and following up on claims with insurance companies to receive payment for medical services rendered to patients. There are various types of medical billing system, including open, closed, and isolated medical billing systems.

Open Medical Billing System

Open medical billing refers to a system where a healthcare provider outsources some or all of the medical billing process to a third-party billing company or service. The billing service takes care of tasks such as coding, submitting claims, and collecting payments, while the healthcare provider retains control over patient records and billing policies.

One of the primary advantages of the open medical billing system is that it can be more cost-effective for healthcare providers. They do not have to invest in expensive billing software or hire and train a dedicated billing staff. Instead, they can contract with a third-party billing service that can offer specialized expertise and knowledge in medical billing codes and procedures. This can help to improve accuracy and efficiency in the billing process.

Additionally, the open medical billing system can provide greater flexibility for healthcare providers. They can adjust the level of services provided by the billing service based on changing needs or circumstances. This can be particularly beneficial for healthcare providers that experience fluctuations in their billing volume or that operate in a seasonal or cyclical business.

However, the open medical billing system can have some disadvantages. One of the primary concerns is the potential loss of control over the billing process. Healthcare providers may worry about the accuracy, efficiency, and privacy of their patient records and billing policies when they outsource the billing process to an outside company. They may also have to pay fees or commissions to the billing service, which can impact the bottom line.

Closed Medical Billing System

Closed medical billing refers to a system where the healthcare provider handles all aspects of the billing process in-house. This includes coding, submitting claims, and collecting payments from insurance companies and patients.

One of the primary advantages of the closed medical billing system is that it offers greater control over the billing process. Healthcare providers have direct access to patient records and billing policies and can ensure that they are accurate, efficient, and secure. This can provide peace of mind for healthcare providers and their patients.

In addition, the closed medical billing system can be more cost-effective for healthcare providers in the long run. Although there may be an initial investment in billing software and staff training, the costs can be recouped over time as the healthcare provider builds up an in-house billing team.

However, there are some potential drawbacks to the closed medical billing system. It can be more time-consuming and resource-intensive for healthcare providers, as they have to handle all aspects of the billing process themselves. This can take away from their ability to focus on providing high-quality patient care. Additionally, the healthcare provider may not have the same level of expertise and knowledge in medical billing codes and procedures as a dedicated billing service.

Isolated Medical Billing System

Isolated medical billing is not a recognized type of medical billing system, but it can refer to the process of billing for medical services provided in remote or underserved areas. Healthcare providers in these areas may face unique challenges, such as limited access to technology and resources, and may need to adapt billing processes to account for these challenges.

One of the primary considerations for isolated medical billing is the need for flexibility. Healthcare providers may need to use alternative payment methods, such as cash payments or mobile payment systems, to account for the limited resources and technology available in isolated areas. They may also need to simplify the billing process to ensure that it is easy to understand and use for both healthcare providers and patients.

In conclusion, the type of medical billing systems that a healthcare provider uses depends on their specific needs, resources, and circumstances. Open medical billing can offer cost savings and specialized expertise, while closed medical billing can offer greater control and security. While not a recognized type of billing system, isolated medical billing may require specialized approaches to account for unique challenges in remote or underserved areas.


Recently, people all around the world have dealt with covid-1, and we are still fighting its side effects in different domains. Moreover, we can see a prominent impact on financial conditions as the rate of unemployment has abruptly increased these days. In such a scenario, we take an overview of the US healthcare industry, and medical billing services are no exception. We observe that there is also a substantial increase in the number of denials for claims submitted by medical billing and coding companies. We can list multiple factors that have proved to be a hurdle for successful reimbursement and denial management.

Therefore, we should be more concerned to address these insurance denials. The reason might be any, but what we can assure is, an accurate billing process that improves medical billing and ultimately cleans the financial strains in healthcare. Only then a provider can practice the promised care on their patients.

Listed below are some of the crucial measures professional medical billing services do to effectively tackle insurance denial. Let’s dig in!

 Verify Patient Details Beforehand 

Insurance denials frequently occur due to errors in the prior authorization process. Often medical practices either have staff shortages or non-serious members in the teams. In any case, the consequence is the same when the required information is not even processed, and if processed, the team does it carelessly.

It is the general manner and the utmost protocol to attend to a medical patient to get their necessary information first. Respective staff in a healthcare facility, usually a receptionist, do this job.

They check and verify the patient’s insurance ID and details like; whether their insurance company covers the services that the patient needs for treatment, general terms, and policy of insurance, and some demographic information of the patient, such as their name, family, residence, medical history, appointment, etc.

If the relevant medical billing services staff make clear moves and gather relevant and correct patient data either on their first appointment or check-in, we can avoid insurance denial to a greater extent.

Set Reminders for Recalling Patients of their Duties 

A provider must deliver medical assistance and care to the patients. They are always committed to adding their sincere efforts to help their patients deal with their illnesses.

However, there are some responsibilities on the patients’ side too. And, they must be mindful of them.

One such responsibility of patients is to pay for the services they receive during their Medicare part B stay and subsequent visits for a check-up, meaning co-payments and deductibles as this might be another cause of insurance denials.

Before moving for an effective denial management option, why not try to knock out this cause?

We can arrange a reception area in the hospital to facilitate the patients as well as explain to them what is due on their part. Also, we can take their sign-on acknowledgment forms so that they get informed of their duties, or we can simply generate emails from time to time. Generally, medical billing services practice this option.

  •  Hire a Competent Staff 

Medical billing is a sensitive job that decides the growth and financial status of any practice. That’s why hiring expert and competent medical billers and coders are a requirement of the job.

Only expert medical billing services can know how crucial it is to pay attention to the training and education of the required staff. They safely process accurate data about patient information, given treatments, and their coding to avoid denials.

  Update Your Medical Billing Software

Instead of dealing with complex medical information manually and bearing insurance denials due to several manual errors, why not use updated medical billing software like EHR?

Alongside this, we can automate several repetitive tasks of medical billing services via RPA. All such mediums are safer options as compared to traditional billing software unless you are using an advanced version of them.

  •   Get the Filling Done on Time 

A medical billing officer must be quick in their actions. They must fill up the details for claim submission for each Medicare patient and send it to the clearing house as soon as possible to get on-time reimbursements. However, rechecking can help them in abolishing the chance of any insurance denial.

  •   Go for Medical Billing Audits at Times 

Sometimes, a practice thinks that they are working fine and have the best team for handling a variety of steps in medical billing services, but still, they get claim denials.

This puts a question mark on them. They try to figure out their mistakes but could not do so as everything seems sophisticated and complex for them to examine as a whole.

Therefore, having a medical billing audit frequently is a good option instead of dealing with denial management repeatedly. Even though the practice is working fine, still it is highly recommended to get an audit for better performance of the practice.


Claim submission is already a tough job for the medical billing services team. So, if they get an insurance denial, this is ultimately a waste of the staff’s work and time.

Therefore, we must avoid claim denials by wiping out all the factors contributing to any claim rejection. Still, if you receive any denial, then the medical billing and coding team must give an immediate response with effective denial management to avoid financial constraints for their practice.




MedICD is best provider of innovative health information system and services that transform healthcare organizations' administrative and clinical operations. All rights reserved.