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Revenue cycle notes
Articles on the parts of medical billing that decide whether a claim is paid the first time — written for the people who run the practice, not for search engines.
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What is a clean claim rate, and what should yours be?
A clean claim rate tells you how often claims clear initial edits without someone having to fix them. For an established billing operation, 95% or higher is a practical operating target — and the workload difference between 90% and 98% is larger than it looks.
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- CMS defines a clean claim as one that needs no development outside the contractor's own operation; HFMA turns that into a measurable KPI.
- 95% is a sound management target, not an HFMA-published industry benchmark — the distinction matters when you report it.
- Clean claim rate measures first-pass quality. It is not the same as denial rate, and a clean claim can still be denied at adjudication.
More articles
Denial management: sort denials by cause before you work them
Denial management means finding out why payers refuse claims, recovering the ones worth appealing, and removing the causes that generate the rest. The published evidence points squarely at the front end of the cycle.
Read · 6 min readHow to read a remittance advice without guessing
A remittance advice tells you what the payer decided and why, but only if you read the adjustment codes in the right order. Here is the sequence that turns an ERA into a work queue instead of a filing exercise.
Read · 2 min readWhy medical coding accuracy drives revenue cycle performance
Practices rarely lose revenue dramatically. They lose it line by line, claim by claim — and coding is where clinical care becomes billable revenue. Get it wrong and everything downstream breaks.
Read · 7 min readThe five checks that stop a claim from being denied before you send it
Most avoidable denials are decided before a claim leaves the practice. Here is the pre-submission sequence — eligibility, benefits, authorization, coding linkage, and demographics — that protects first-pass resolution.
Read · 7 min readHow to turn CARC and RARC codes into a denial prevention plan
Working denials one by one keeps a queue moving without ever making it smaller. Grouping reason codes by cause — front desk, coding, contractual, or payer behavior — turns the same data into a prevention plan with an owner.
Read · 8 min readDays in A/R is a symptom, not a diagnosis
A rising days-in-A/R number tells you something is wrong, not what. Four checks separate a genuine collection problem from a posting problem, a charge-entry lag, or a single payer holding claims.
Read · 6 min readHow does your A/R and denial rate compare?
Free benchmark tool — enter six numbers, see your bands against published industry sources, and download a branded PDF.