If You Are Not Scrubbing Your Claims You Are Losing Money
Submitting clean claims is critical to a strong medical billing process. A fundamental element of good process design is to catch problems as soon in the process as you can. Correcting a diagnosis error before a claim is submitted may take 5 minutes; correcting it after the claim has been denied will take well over an hour (and it will delay collections by 3o or more days).
Implementing a process that submits clean claims can lead to days in AR of less than 45.
One of the best tools for insuring claims are clean before they are submitted is a claim scrubber. A claim scrubber takes the rules that payers use to adjudicate claims and applies them to the claims befroe they are ever submitted. This eliminates avoidable denials and thus speeds up collections. In addition, it frees up time in the billing process for staff to focus on activities that help increase collections instead of just correcting avoidable problems. Every Medical Billing Company should utilize at least the following scrubbers:
- A minimum requirements scrubber. Such a scrubber insures that the basic elements of the claims are in place (for example, a 9 digit social security number that is not composed of repeating numbers, a valid date of birth, etc).
- Core coding scrubber that compares the claim’s coding to local Medicare and Correct Coding Initiative rules. Such a scrubber should not only identify negative issues (e.g., a diagnosis/procedure mismatch) but also improvement opportunities (e.g., this procedure is typically performed in conjunction with a second, billable procedure, that is missing from this claim).
These scrubbers will lead to a marked improvement versus a billing process with no scrubbing; they are, however, not a complete scrubbing solution. A full solution requires a scrubber that can have a customized rule set that takes the knowledge of the billing company or medical practices and codifies it so that it can be applied to every claim before submission. This scrubber is:
- Knowledge Management Scrubbers that allow the medical billing operation to continually reevaluate the adjudication rules of each payer and update the rules accordingly. The proper implementation of the scrubber requires a clear feedback loop from the follow-up department to the scrubber so that the lessons learned from denied claims can be quickly incorporated in to the scrubber. Any top notch medical billing service utilizes a scrubber like this.
Consistent use of the scrubbers outlined above can decrease a medical practice’s collections cycle by up to 50 days. This is why you need to insure this critical step is being completed no matter who is doing your Medical Billing.
Copyright 2008 Carl Mays II
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