On the face of it, claim scrubbing is the detailed process of verifying all the data on a medical claim before it’s submitted to an insurance company or other payer institution. Yet this might sound very simple. It actually required a meticulous process and a professional eye for catching incorrect information as early as possible.
Though claim scrubbing is about more than just accuracy and billing amounts. When a claim is processed quickly and efficiently it helps the patient, the physician, and the insurer/payer to save time. While scrubbing does take time in the front end, it ultimately saves a lot more time in the long run. A claim that’s riddled with errors, no one gets paid, and everyone is frustrated.
How Claim Scrubbing Saves Money
Medical billers and in-house administrative coding specialists can receive dozens if not hundreds of claims each day. Anytime a claim is incorrectly coded, or there is important information missing, it has a high risk of being denied, suspended, or rejected. This will require the medical coder to repeat the entire process, costing more time and money, than if the claim had simply been scrubbed before submission.
The delays in the revenue cycle, as well as time lost on the payer’s end, can be exacerbated. Corrections, answering questions, or dealing with a possible denial/rejection can cost more than just time and money. If it happens enough an insurance company or a public health institution might red flag your practice for a potential fraud audit.
The Benefits of Claim Scrubbing
Claim scrubbing is of vital importance not only for practices and payer institutions but also for patients. A professionally scrubbed claim helps:
- Reduce the risk of claim rejections.
- Reduce the risk of a claim denial
- Prevent delayed claim payment.
- Reduces the workload on medical coders and billers
- Improves patient interaction
- Improving patient satisfaction levels
How Are Claims Scrubbed
Professional claim scrubbing is designed to detect medical billing code errors before they are submitted to eliminate the risk of them being rejected or denied.
It’s a meticulous process that goes beyond a provider simply making their best effort to enter all information accurately. Most thriving practices with a smooth, consistent revenue cycle implement claim scrubbing as a standard operating procedure before any claim is submitted.
Thou the most effective claim scrubbing tends to come from third-party medical billing services, who are specifically trained to catch errors and omitted data. This also adds an additional layer of scrutiny that extends beyond some of the potential in-house blind spots an individual practice might have in their medical coding and billing infrastructure.
These are professionals who audit claims and are well-versed in every facet of the medical billing process to ensure accuracy. These professional claim scrubbers are often used across a wide range of healthcare facilities. You can often find them working inside or with administrative specialists in:
- Hospitals
- Dentist Offices
- Doctor’s Offices
- Oral Surgeons
- Medical Clinics
- Surgical Centers
- Mental Health Clinics
- Outpatient Care Centers
Regardless of the healthcare sector, these claim scrubbers dutifully check to make sure that form fields are filled in, to not just ensure an accurate claim. They also reduce the risk of claim rejections, denials and reduce the risk of getting red-flagged by a payer institution for an audit.
Common Coding Errors Caught by Claim Scrubbing
Medical coding can be complicated. Especially for specialty practices. Not to mention solo practitioners and small practices where physicians are asked to wear multiple hats. So, it’s no small surprise that coding mistakes can happen. Some of the most common errors that professional claim scrubbers encounter include:
- The accidental use of ICD-9 codes
- The incorrect use of HCPCS
- Incorrect use of CPT code terminology
- Incorrect use of medical terminology
- Improper use of procedure and specialty codes
- Using the wrong code modifiers
- Missing patient contact information
- Incorrect use of code permutations
- Lack of detailed visit data
- HIPAA compliance issues
Choosing Between Manual and Automated Claim Scrubbing
The staggering complexity of claim creation and submission drives many practices to use claims management software to process their claims. Many times, these claims management software programs are sold as standalone products or they’re integrated with a larger suite of medical software, and revenue cycle management programs.
The natural assumption is that these computers can carry out claim scrubbing much faster and more than in-house office staff. The software is also available 24/7. However, this sort of “Hands-Off” approach to medical coding and claim scrubbing is not without its own blind spots. When an error is found in the system it often propagates across dozens if not hundreds of similar claims. Once it’s caught, you end up having a mountain of corrections to handle.
This is why even the most successful medical practices with claim management software suites still employ human eyes to take care of final claim scrubbing. An added set of real, human eyes then catches any digital errors or gremlins in the system before they have a chance of repeating.
The Benefits of Third-Party Claim Scrubbing
When you turn over your claim scrubbing to a professional medical coding and billing specialist like Operant Billing Solutions you get the peace of mind that comes with knowing that highly trained, experienced professionals are ensuring the accuracy of all your claims.
This frees up physicians and staff to focus on patient care. Not only does this boost your patient satisfaction levels, but most small practices find that they actually have more clinical hours available to onboard new patients. This can be especially helpful for mental healthcare practices such as ABA therapists who often have a waiting list of patients who need their services.
When you outsource your claim scrubbing to a third-party agency, the improved accuracy also translates into a more consistent revenue stream. This makes it easier to afford to expand your practice, or perhaps even open up new avenues for marketing your practice to new clients.
Professional claim scrubbing’s ability to reduce errors and requests for resubmission also goes a long way toward preventing audits from insurance companies and public health institutions. Many small practices that have endured an audit choose third-party claim scrubbing to ensure they aren’t selected for another one.
