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What Is Claim Scrubbing?

Leah Zitter
Leah Zitter
business.com Contributing Writer
Updated Aug 29, 2022

Claim scrubbers verify the data on medical claims before submitting them to payers. Here's how it works.

Every medical practice, including telehealth businesses, must submit claims to insurers, and when claims are processed quickly, the patient, provider and insurer all save time, money and frustration. However, if the claims are riddled with errors, no one gets paid and everyone is frustrated. 

Claim errors are hard to avoid, but the practice of claim scrubbing can help. Claim scrubbing detects billing code errors so that the claims a medical practice submits are less likely to be denied.

We’ll explore claim scrubbing, why it’s essential and how automated claim-scrubbing tools can make the process more seamless. 

What is claim scrubbing?

Claim scrubbing is the process of finding and eliminating coding errors on medical claims before practices submit them to insurers. Claim scrubbers – automated or manual – verify the data on medical claims before submitting them to payers. 

To understand claim scrubbing, it’s helpful to understand how the medical revenue landscape works:

  1. Providers submit their bills. 
  2. Medical coders code those bills into concise reports. 
  3. Medical billers fill out two medical claim forms – CMS-1500 and UB-04 – for insurers. 

Medical billers get anywhere from hundreds to thousands of bills daily, depending on the size of their organization, and they have little time to review the accuracy of their reports. If a claim ultimately gets denied or suspended due to an error, the medical billers must repeat the entire process, creating cash flow problems and increasing the company’s time and labor overhead costs.

Claim scrubbers are usually a part of a third-party medical billing service. It’s their job to audit the medical bills to ensure accuracy. Scrubbers are employed across healthcare facilities, including hospitals, dentists, doctor’s offices and outpatient centers. Some scrubbers check that form fields are filled in, while others conduct a more meticulous audit for accuracy. 

The auditing process can be done either manually or by computer, although most claim audits are automated these days. 

Manual vs. automated claim scrubbers

Medical coding is incredibly complicated, so it’s no wonder coding mistakes can happen. Here’s a look at some of the complexities coders face. 

  • ICD-9 codes: Medical coders must be thoroughly acquainted with each of the 13,000 diagnosis codes and 3,000 procedure codes of the ICD-9 (International Classification of Diseases, Ninth Revision), the official code assignment system in the U.S.
  • HCPCS and CPT codes: Coders must know the thousands of HCPCS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) codes.
  • Knowledge of medical terminology: All agents must be familiar with medical terminology and anatomy to understand what they’re reading.
  • Procedure and specialty codes: Coders also must know the most frequently used procedures and specialty codes while staying abreast of coding changes.
  • Code permutations: Code permutations must accurately and thoroughly represent a patient’s visit as described in the original surgical records, office notes, laboratory notes or pathology findings.
  • Detailed visit data: Coders’ reports must include personal details about the patient, healthcare provider, individual physicians, and medical staff, as well as all diagnoses, procedures, treatments and tests that have been carried out.  
  • HIPAA compliance: All documents must be HIPAA-compliant.

Because of coding’s staggering complexity, most practices use healthcare claims management software to process their claims rather than manual processing. Claims management software is sold either as a standalone product or bundled within the best medical software, revenue cycle management software or comprehensive medical practice management software. 

Computers do the job much faster and more accurately than front-office staff, and they’re available around the clock. Ultimately, automated solutions save healthcare organizations time and money, resulting in more motivated employees and a better patient experience.

Did you know?Did you know? Some common reasons for claim rejections are an incorrect CPT code for the report date, a missing or incorrect diagnosis code, lapsed patient membership, invalid member ID, and no admission date on an inpatient claim.

How does a claim scrubber work?

There are two kinds of claim scrubbers: those that audit for complete information and those that audit for accuracy. Both types of claim scrubbers check for errors after reports have been created and are ready to submit but before they’re filed with insurers. If a claim scrubber finds a mistake, they’ll flag it for a medical coder or biller to fix.

You may have also heard the term “charge scrubber.” A charge scrubber is similar to a claim scrubber. While a claim scrubber audits medical billing reports before they’re submitted to an insurer, a charge scrubber audits reports before medical billers even compile the claim. 

Both claim scrubbers and charge scrubbers ultimately provide the same benefits, but charge scrubbers flag billing errors before claims have been created, while claim scrubbers flag for errors after they’ve been created.

Why is claim scrubbing important?

Claim scrubbing is critical for practices and patients and should be an integral part of any medical billing process. When a billing report has errors, these are some potential adverse effects: 

  • Less accurate claims
  • Increased denials
  • Delayed payments
  • More work on billing and less time for crucial work, including patient interaction and research
  • Aggravated payer relationships, as payers dislike flawed claims
  • Aggravated client relationships, as clients dislike having their claims denied

This means that automated claim scrubbing has some important benefits. 

  • Accurate claims: Insurers receive accurate claims the first time around, resulting in fewer denials and easier access to reimbursement. 
  • Expedited payments: Since denied payments slow down the reimbursement process, accurate claims result in expedited payments, boosting revenue and increasing cash flow
  • More time for crucial business tasks: With a smoother billing process, the organization and its employees can dedicate more time to marketing, patient care and research.
  • Improved client relationships: Client patients are likely pleased with their timely payments and are more likely to remain with the medical practice. 
  • Improved payer relationships: Payers appreciate meticulously accurate reports and spend less time and effort rectifying faulty claims, resulting in reduced overhead. 

5 code-scrubbing software tools

The top code-scrubbing tools address the needs of medical practices of varying sizes and budgets while considering specialties and other needs. Here’s a look at five solutions to consider. 

  • Optum: Optum expedites the bill-scrubbing process through its immaculate and fast auditing. The system automates claims review to catch errors, omissions and questionable coding. A support team assists with editing standard, specialty and custom rules.
  • Claim Editing Software: Claim Editing Software, a 30-year-old company, analyzes claims for more standard, built-in edits than its competitors. Its detailed reports explain edits in user-friendly language. The service, with its additional proprietary database, doubles the amount of CPT codes to cover all possible ICD-9/CPT code combinations. Its medical content database is regularly updated and improved for detailed and accurate results.
  • ClaimWizard: ClaimWizard Pro provides a software wizard setup assistant that helps users select more precise codes and eliminate coding oversights. Its cross-walk feature automatically matches ICD codes with the appropriate CPT/HCPCS codes. Its built-in edits ensure claims meet all nationally accepted coding guidelines and standards.
  • Code-A-Note: Code-A-Note software uses natural language processing to select and validate appropriate codes to ramp up coder accuracy and efficiency. Its big data is collated from vital sources, including the U.S. National Library of Medicine, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, National Center for Health Statistics, and American Medical Association.
  • Billing Bridge: Billing Bridge is a mobile app that makes billing easy for medical managers right from their smartphone, helping them analyze and gather data on their finances. The tool also gives them real-time claim-payment updates and alerts. This code-scrubbing software tool focuses on the ROI of the bill-scrubbing process.

Claim-scrubbing solutions reduce auditing time by at least 10%. The technology also provides the most compatible code the first time around, preventing the 15% to 20% of cases in which bills have to be re-coded, according to MDWizards.

Did you know?Did you know? Practice management solutions can reduce physician burnout by reducing the pressure on care providers and improving staff workflows.

Medical billing services that include code scrubbing

Top medical billing services include code-scrubbing functionality as well as the ability to verify insurance and schedule appointments. To learn more about medical billing services with code scrubbing, check out these in-depth reviews:

Claim-scrubbing terms you should know

Familiarize yourself with these common claim-scrubbing terms. 

  • Superbills: Superbills are the itemized lists of services provided to the patient; they’re the primary source used for creating claims.
  • CMS-1500 and UB-04: CMS-1500 and UB-04 are the most common medical forms used for compiling patient case history and billing claims.
  • Claim-editing tools: Claim-editing tools, or claim-scrubbing software, are integrated with electronic health record or practice management systems to ensure that claims are billed at the actual contracted amount, coded accurately and processed as quickly as possible.
  • Charge review rules engines: Charge review rules engines review, correct and apply millions of coding rules to submitted claims to ensure billing accuracy.
Leah Zitter
Leah Zitter
business.com Contributing Writer
Leah Zitter PhD is a trained journalist who covers emerging technology across more than 60 industries. Her PhD is in Behavioral Neuroscience which beautifully intersects with the AI/ ML topography. Clients include Google, AWS and Microsoft.