What Is Claim Scrubbing?

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, whether automated or manual, verify the data on medical claims before submitting them to payers. 

To understand claim scrubbing, it’s helpful to learn how the medical revenue landscape works. There are three main steps:

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. 

Depending on the size of their organization, medical billers receive hundreds to thousands of bills daily, and they have little time to review the accuracy of their reports. If a claim is ultimately 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 part of a third-party medical billing service. It’s their job to audit medical bills to ensure accuracy. Scrubbers are used in most healthcare facilities, including hospitals, dentists, doctor’s offices and outpatient centers. Some scrubbers ensure forms are filled in correctly, while others conduct a more meticulous audit for accuracy. 

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 check for errors after reports have been created and are ready to be submitted but before medical claims are filed with insurers. If a claim scrubber finds a mistake, they’ll flag it so a medical coder or biller can fix it.

You also may have heard the term “charge scrubber.” A charge scrubber is similar to a claim scrubber, but there’s a difference: Whereas a claim scrubber audits medical billing reports before submitting them to an insurer, a charge scrubber audits reports before the medical biller even compiles the claim. 

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

Manual vs. automated claim scrubbers

Claim scrubbing can be completed by manual claim scrubbers or automated claim scrubbing software. 

• Manual claim scrubbing: Manual claim scrubbing is performed by employees or contractors who handle medical coding. If you opt for a manual claim scrubber, make sure to invest in an expert. While your staff may be experienced, effective claim scrubbing requires extensive training. Proper medical billing and coding entails knowledge of over 3,000 medical codes, medical terminology and HIPAA regulations. You’ll need someone with robust credentials who is willing to stay updated in the industry. 
• Automated claim scrubbing: The industry is shifting toward automated claim scrubbing performed by software. Automated solutions scrub claims quickly and accurately. They can catch errors that manual scrubbers may miss, thus lowering your chances of denied claims and bolstering your organization’s credibility. The software can be acquired through a one-time installation, or it can be incorporated into your medical practice management solution. 

Why is claim scrubbing important?

Claim scrubbing is essential for practices and patients and should be integral to 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

Automated claim scrubbing can bring your practice the following benefits:

• Accurate claims: Insurers receive accurate claims the first time around, resulting in fewer denials and easier access to reimbursement.
• Expedited payments: Because denied payments slow down the reimbursement process, accurate claims result in expedited payments, thereby 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 to be pleased with their timely payments and are more likely to remain with the medical practice.
• Improved payer relationships: Payers appreciate meticulous reports and spend less time and effort rectifying faulty claims, resulting in reduced overhead. 

Code-scrubbing software tools

The top code-scrubbing tools address the needs of medical practices of various sizes and budgets while considering specialties and other requirements. Here are five solutions to consider: 

• Billing Bridge: Billing Bridge is a mobile app that makes billing easy for medical managers to do right from their smartphones. The tool helps them analyze and gather financial data and provides real-time claim-payment updates and alerts. This code-scrubbing software focuses on the bill-scrubbing process’s return on investment.
• ClaimWizard Pro: ClaimWizard Pro provides a software wizard setup assistant that helps users select more precise codes and eliminate coding errors. The cross-walk feature automatically matches ICD codes with the appropriate CPT or Healthcare Common Procedure Coding System (HCPCS) codes. The built-in edits ensure that claims meet all nationally accepted coding guidelines and standards.
• 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.

Best medical billing services for claim scrubbing

The best medical billing services often include code-scrubbing functionality along with insurance verification and appointment scheduling tools. Consider the following well-regarded options: 

• AdvancedMD: This customizable service is easily integrated into most medical practices and offers a code library to support your certified medical coders. Our AdvancedMD review explains how this platform’s certified billers will scrub your claims and submit them to insurers.
• athenaCollector: If you’re looking for optimization and you already have a certified medical coder, athenaCollector may be your best option. As our athenaCollector review explains, this service offers easy reporting and allows you to compare your data to other companies’.
• CareCloud: No matter your organization’s size, CareCloud can provide the perfect package. This solution allows practices to choose which tasks to handle internally and which ones CareCloud will take over. Read our CareCloud review to learn about this platform’s CollectiveIQ billing engine, which checks every claim for possible denials or errors before submission.
• DrChrono: If you have a small budget for your claim scrubbing needs, DrChrono might be the right fit. Along with a 96 percent first-pass claims rate, DrChrono is known for its reliable customer support and e-ticket tracking system. Our full DrChrono review explains this platform’s billing and claim-scrubbing processes.
• Tebra: With an intuitive interface, Tebra (formerly known as Kareo) makes claim tracking and submission simple. Tebra works with various independent medical billing partners, matching users to the best option for their organization’s needs. Read our detailed Tebra review to learn about its built-in rules engine that scrubs your claims for inaccurate codes before submission.

Claim-scrubbing terms you should know

Familiarize yourself with these standard claim-scrubbing terms: 

• Superbills: Superbills are itemized lists of services provided to the patient; they’re the primary source of claim creation.
• CMS-1500 and UB-04: CMS-1500 and UB-04 are the most common medical forms for compiling patient case histories and billing claims.
• Claim-editing tools: Claim-editing tools, or claim-scrubbing software solutions, are integrated with electronic health record or practice management systems to ensure claims are billed at the 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.

Codes used in medical claims

Medical coding is incredibly complicated, so it’s no wonder coding mistakes can happen. Here’s a look at some of the issues involved: 

• ICD-9 codes: Medical coders must be thoroughly acquainted with the 13,000 diagnosis codes and 3,000 procedure codes of the International Classification of Diseases, Ninth Revision (ICD-9), the official code assignment system in the U.S.
• HCPCS and CPT codes: Coders must know the thousands of HCPCS and CPT 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 must know the most frequently used procedures and specialty codes and stay 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, and all diagnoses, procedures, treatments and tests that have been carried out.
• HIPAA compliance: All documents must be Health Insurance Portability and Accountability Act (HIPAA) compliant.

Because of coding’s staggering complexity, most practices use healthcare claims management software rather than manual methods to process their claims. Ultimately, automated solutions save healthcare organizations time and money, resulting in more motivated employees and a better patient experience.

Leah Zitter contributed to this article.