The Real Cost of a “Clean” Claim

By Elizaveta Bannova, CPC, CPCO, CPMA, CFPC, Billing Department, WCH

There’s a myth floating around most practices that a claim is “clean” the moment the clearinghouse accepts it. It isn’t. A claim only proves itself clean on the day someone pulls the chart during a post-payment review and it actually holds up — diagnosis supports the service, the note supports the code, the modifier has a real clinical reason behind it, nothing was billed from memory instead of documentation. Everything before that moment is just a claim that hasn’t been tested yet.

That’s the core idea behind a recent WCH Service Bureau webinar led by Elizaveta Bannova, and it’s worth sitting with for a minute, because most of the revenue a practice loses in a given year isn’t stolen through fraud. It’s given away, quietly, through process gaps nobody happened to flag in time.