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In an industry where healthcare providers are often facing claim denials, claims scrubbing in medical billing has become one of the ways to solve this issue.
Healthcare providers dedicate what took a lifetime to studying and mastering their craft to save lives. But with all those years of learning, there is not a single masterclass on how medical billing works.
Unfortunately, when healthcare providers lack the experience to bill claims correctly, insurance companies will reject their claims, and inefficient or inaccurate medical claims can take a big bite out of their revenue.
According to research, it costs an average of $118 to process a denied claim. This back-and-forth in medical claims costs healthcare providers their precious time and money.
To reduce the rate of claims rejection, more and more healthcare providers are now investing in claims scrubbing in medical billing.
Keep reading as Unify Medicraft takes us through the meaning of claims scrubbing, how it works, and the role it plays in making sure medical billing is accurate.
What is Claims Scrubbing in Medical Billing?
Claims scrubbing in medical billing is carried out by checking medical claims for coding errors before they are submitted to the insurance company. This increases claim accuracy and the chances to get faster reimbursement from insurance companies.
Every healthcare professional must submit claims to their patient insurance company to get paid. Quick and accurate claims processing save patients, healthcare providers, and the insurance company time and money while avoiding frustration. However, when claims are filled with many human errors, no one gets paid.
In the past, claims scrubbing was done manually in a long and stressful process. However, in the digital age, more and more healthcare providers are investing in claims-scrubbing software to accelerate the process of their medical billing.
How Does Claim Scrubber Work?
Claim scrubbers find mistakes on medical claims and flag them so the medical coder or biller can fix them before submitting them to insurance companies. There are claim scrubbers that check if all required fields in a medical billing report are filled correctly and those that check for accuracy in the information.
With this solution in place, medical claims are more accurate, and healthcare providers have the peace of mind that comes with knowing they will be paid for the service they provide.
What are the Benefits of Claims Scrubbing in Medical Billing?
Let’s take a look at some of the benefits of claims scrubbing in medical billing.
Faster Reimbursement
It is evident that claim scrubbers speed up medical reimbursement by improving accuracy and ensuring all required fields in a medical billing report are filled correctly before they are submitted. By reducing the number of rejected claims, healthcare providers get paid for their services faster.
Reduced Claim Denials
Claim scrubbers look for errors in medical claims so that there will be no denials from insurance companies. It also ensures medical claims are accurate, complete, and meet the specific requirements of insurance companies.
Better Cash Flow
It is true that when healthcare providers are paid on time by insurance companies, their revenue also improves. As a result, it is easier for healthcare providers to cover operating expenses and invest in other areas of their practice.
Increase Practice Efficiency
When claim scrubbers check for errors in medical billing and they are corrected, it minimizes the task of administrative staff and saves their time. Not going over medical claims to check for errors and resubmitting them also streamlines the billing process and accelerates reimbursement timelines.
Increase Staff Productivity
Since the claims scrubber is responsible for going through medical claims and is faster, it reduces countless hours your staff will use trying to check for any form of error in the patient's medical claim. This process makes them focus on other important aspects of your business and improves productivity.
Compliance with Insurance Regulations
It is not news that Insurance companies across the country do not have the same regulations for claim submission. Therefore, healthcare providers must follow the guidelines of the insurance company their patient is using when they want to submit medical claims. Using claim scrubbers ensures each claim follows these regulations and also avoids any issues that can arise from non-compliance.
Manual vs. Automated Claim Scrubbers
Manual Claim Scrubbers
Manual claim scrubbers are done by administrative staff or contractors who check medical claims to be sure the codes are correct, and other information is complete before they are submitted to insurance companies. When you opt for manual claim scrubbers, it is important to work with an expert with credentials as they have knowledge of medical codes, medical terminology, and the Health Insurance Portability and Accountability Act regulations.
Automated Claim Scrubbers
With the development of technology, the healthcare industry is now moving toward using automated claim scrubbers. These are software that catches errors quickly and accurately better when compared to manual scrubbers. Thus, lowering the chances of denied claims and increasing the revenue of healthcare providers.
How to Improve Claims Scrubbing Process?
Healthcare providers can improve their claim-scrubbing process in the following ways:
Use the Right Software
Submitting an accurate medical claim is known to hasten reimbursement and claim scrubber software also helps improve medical claim accuracy. Using this software detects errors and inconsistencies in medical claims faster, thereby streamlining the process and ensuring clean claims before submission.
Train Your Coding Staff
When healthcare providers organize regular training sessions for their billing and coding staff, it helps them to know about the latest coding guidelines and insurance companies' policies. With professional coding staff, it is very easy to detect potential errors and correct them during the claim scrubbing process.
Perform Internal Audits
When healthcare providers perform internal audits of the claim scrubber, they are able to see any form of pattern and errors in their medical claim.
It also shows them where their coding team needs improvement and the type of training they need. This process ensures medical claim accuracy and insurance compliance.
Build Good Relationships with Insurer
When healthcare providers have a good relationship with insurance companies, it is a great chance to talk to them directly when they face any issues with their requirements. With this type of communication, healthcare providers are able to minimize claim rejections and denials.
Claim-Scrubbing Terms You Should Know
Superbills
Superbills are detailed receipts that contain lists of services provided by a healthcare provider to the patient. Superbills play an important role in medical billing.
CMS-1500 and UB-04
CMS-1500 and UB-04 are the most common forms used to submit medical claims to insurance companies. This form often contains patient case histories and billing claims.
Claim Editing Tools
Claim-editing tools are specific types of software integrated with electronic health records to identify and correct errors in medical claims. They also ensure medical claims submissions follow the industrial regulations and are processed as quickly as possible.
Charge Review Rules Engines
Charge review rules engines are applications that make use of artificial intelligence to review, correct, and apply millions of coding rules to submitted claims for billing accuracy.
Codes Used in Medical Claims
ICD-9 Codes
The International Classification of Diseases, Ninth Revision (ICD-9) is used to assign codes to diagnoses and procedures in the healthcare industry in the United States. Medical coders must have knowledge of 13,000 diagnosis codes and 3,000 procedure codes to work professionally.
HCPCS and CPT Codes
Healthcare Common Procedure Coding System and Current Procedural Terminology are medical billing codes used when billing medical claims.
Knowledge of Medical Terminology
Medical coders must be familiar with medical terminology and anatomy to translate them into the right code.
Procedure and Specialty Codes
Medical coders must know the code for each medical procedure and stay abreast of coding changes in the healthcare industry.
Detailed Visit Data
Medical coders’ reports must include the following:
- Personal details about the patient
- Healthcare provider
- Individual physicians and medical staff
- Diagnoses and procedures
- Treatments and tests that have been carried out for patient
HIPAA Compliance
Medical coders must ensure their medical claims comply with the Health Insurance Portability and Accountability Act.
How to Get Started with Claim Scrubbers
Ready to use a claim scrubber in your medical claim? The first thing you need to do is to understand how the claim scrubber software works and get the one that works well for your practice.
After choosing the software, integrate it into your Electronic Health Record and train your coding team on its functionalities and other latest coding guidelines. Lastly, ask for feedback to detect error patterns in your medical claim.
AI-Powered Claim Scrubbing
The process of claim scrubbing has come a long way from just manually checking every claim for errors to the development of automated claim scrubbing tools. The use of artificial intelligence also makes reviewing of medical claims for errors more straightforward and streamlined.
Common Billing Mistakes that Claim Scrubbing Can Help to Avoid
Claim scrubbing in medical billing helps to detect errors and make your claim accurate with faster reimbursement. Here are some of the common mistakes that claim scrubbing will help you avoid in your medical claim:
- Missing or Incorrect Documentation
- Typographical Errors
- Duplicate Charges
- Incorrect Coding
- Insurance Verification
- Overbilling or upcoding
- Incorrect Final Statement Balances
Benefits of Outsourcing Claim Scrubbing to a Third-Party Agency
When healthcare providers outsource their claim scrubbing to a professional, they are at peace knowing that the highly trained, experienced medical coders are ensuring the accuracy of all their claims.
Focus on Patient Care
Outsourcing claim scrubbing gives healthcare providers all the time in the world to take good care of their patients. Not only does this boost patient satisfaction, but small practices actually have more hours to attend to new patients. This is especially helpful for mental healthcare providers which often have many patients who need their services.
Improved Accuracy
When you outsource your claim scrubbing to a third-party agency, it improves your medical code accuracy which directly leads to a more consistent revenue stream. This makes it easier to expand your practice and attend to new clients.
Reduce Coding Errors
Healthcare providers should choose third-party claim scrubbing to reduce their coding errors and prevent audits from insurance companies and public health institutions.
Conclusion
Medical billing is becoming increasingly complex in the healthcare industry. However, the introduction of claims scrubbing in medical billing is revolutionizing the way medical claims are processed and submitted. This has given healthcare provider assurance they can receive faster reimbursement for the services that they provide for their patients.
If you’re looking to streamline your billing with medical billing software, Unify Medicraft expedites your claim process so that you can receive your reimbursement on time.
Frequently Asked Questions
Why is Claim Scrubbing Important for Healthcare Providers?
Claim scrubbing is important to healthcare providers because it ensures the accuracy of medical codes and compliance with regulations in medical billing. With these, claim denial from insurance companies is reduced and there is faster reimbursement for healthcare providers.
What Type of Code do Claim Scrubbers Analyze?
- International Classification of Diseases
- Current Procedural Terminology
- Healthcare Common Procedure Coding System
What Errors in Claims Scrubbing?
Error in claim scrubbing errors are mistakes identified by claim scrubber software when reviewing a medical claim.
What is a Clean Claim in Medical Billing?
A clean claim in medical billing is the process of ensuring a medical claim is without error and completed before submitting it to the insurance company.