Is Your Medical Billing Company Scrubbing Your Claims?
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.
The leading medical billing services utilize scrubbers that ensure your claims are clean before they are submitted to payers. These scrubs accelerate the speed of collections by avoiding denials and delays. They also increase collections by minimizing the volume of “re-work” and allowing billing staff to focus their efforts on pursuing true collections improvement opportunities and not simply resubmitting claims that should have been paid the first time. As a result of these scrubbers, over 90% of claims submitted are paid upon first submission. These “scrubbers” include:
- A baseline scrubber. This scrubber insures that the claim has at least the basic information such as a social security number, properly formatted insurance id number, etc.
- Scrubber that checks coding, bundling, and procedure information versus local Medicare and CCI rules. This scrub assures better coding, identifies overlooked procedures or codes.
The scrubbers outlined above are a basic service that any medical billing company should offer. Medical billing companies should also be able to utilize medical billing specific know-how and business intelligence created over time through work with many clients across specialties and geographies to create their own proprietary set of claim scrubbing rules. This third type of scrubber is a:
- Dynamic Proprietary Rule scrubber that checks for optimal coding and documentation versus each particular payer or plan’s rules. This scrub assures that each claim is optimized for clean submission. When the payer or plan’s rules change or when the billing office detects a systemic issue they should update the scrubber to filter and fix problems before claims are submitted. These specialized scrubbers differentiate the Tier one medical billing companies from the rest of the crowd and can make a significant collections difference.
Medical Practices will see a significant improvement in both the speed and the magnitude of collections if the begin using the scrubbers outlined above. With all of the technology payers employ to minimize the amount they pay to providers, it is difficult to survive without utilizing these scrubbers.
Copyright 2008 Carl Mays II