Claim Scrubbers Are A Critical Medical Billing Component
A well designed medical billing process does not allow errors to propagate. This design tenant results in less effort required to collect payments and payments arriving much faster. One of the most important manifestations of this concept is insuring that claims are clean before they are submitted to payers.
A process that insures claims go out the door clean can lower a practice's AR to well under 45 days.
If claims are indeed submitted clean, then over 90% can be paid after the first submission. This leaves a much smaller number of "real" issues for the medical billing staff to pursue. By eliminating avoidable errors, collections accelerate and increase (since in many billing offices there is no time to perform basic tasks like no response calls). A key tool in realizing these improvements is a claim scrubber. These scrubbers, which are used by all leading medical billing services, compare claims to the rules utilized by payers to decide if a claim will be paid. 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.
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