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.
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:
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.
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.
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.
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.
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.
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:
This means that automated claim scrubbing has some important benefits.
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.
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.
Practice management solutions can reduce physician burnout by reducing the pressure on care providers and improving staff workflows.
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:
Familiarize yourself with these common claim-scrubbing terms.