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What to know about claim scrubbing

What Do You Need To Know About Claim Scrubbing?

What Is Claim Scrubbing?

Claim scrubbing is the method of identifying and correcting coding problems on medical claims before submitting them to insurers. Whether automated or manual, claim scrubbers validate the information on medical claims before sending them to payers.

Understanding claim scrubbing requires knowledge of how the medical revenue environment works:

  • Providers submit bills.
  • Medical coders organize such bills into brief reports.
  • Medical billers complete two medical claim forms for insurers: CMS-1500 and UB-04.

Third-party medical billing services typically employ claim scrubbers. It is their responsibility to ensure the correctness of the medical bills. Scrubbers are used in various healthcare settings, including hospitals, dentists, physician practices, and outpatient centres. Some scrubbers ensure that form fields are filled out, while others perform thorough audit for accuracy. The auditing procedure varies greatly based on the complexity of the claim. Auditing procedure can be done manually or by technology, though most claim audits are now automated.

Manual Vs Automated Claim Scrubbers

Medical coding is so complicated that it’s no surprise that coding errors occur. Here are some of the difficulties that coders confront.

ICD-9 codes:

Medical coders must be extensively familiar with the ICD-9 (International Classification of Diseases, Ninth Revision), the official code assignment system in the United States, with 13,000 diagnosis codes and 3,000 procedure codes.

HCPCS and CPT codes:

Coders must be familiar with thousands of HCPCS (Healthcare Common Procedure Coding System) and CPT (Current Procedural Terminology) codes.

Knowledge of medical vocabulary:

To grasp what they’re viewing, all employees must have understanding about medical terms and physiology.

Procedure and specialty codes:

Coders must also be familiar with the most often used processes and specialty codes and should stay up to date on coding changes.

Code Permutations:

Code permutations must precisely and completely describe patient’s visit as documented in the original surgical documents, office notes, laboratory reports, or pathology findings.

Detailed Visit Data:

Coder’s reports should include personal information about a patient, healthcare professional, individual doctors, and medical personnel, as well as any diagnoses, operations, treatments, and tests performed.

HIPAA Compliance:

HIPAA compliance is required for all documents.

What Is The Significance Of Claim Scrubbing?

The significance of claim scrubbing cannot be understated. Claim scrubbers should be used in every practice’s medical billing procedure for the following reasons:

More Precise Claims 

The most obvious advantage of claim scrubbing is that it produces more precise claims. You will receive fewer denials, if your claims are frequently correct. As a result, you’ll face fewer challenges in obtaining funds from payers.

Time Saving

Manually reviewing your claims for inaccuracies is not just a quick method to make errors; it is also time-consuming. Your staff will spend considerable time on the procedure with claim scrubbers. Instead, a computer programme completes the task more swiftly and efficiently. You’ll catch considerably more problems quickly, and your front-office employees will have more time to contact patients.

Improved Payer Relationships

92 percent of Americans were covered by health insurance in 2019. This means that payers are the key revenue source for healthcare institutions. Submitting inaccurate claims to these payers is a definite way to be on their negative sides, particularly. Why would a payer continue to work with you if you constantly break their rules? Claim scrubbers solve that.

They significantly reduce the number of incorrect claims you file, resulting in improved relationships with your payers. Excellent claim-scrubbing techniques can also assist you in making a case for yourself when contacting new insurers to expand your network. Following that, more patients will be able to choose your practice.

Improved Patient Interactions

Frequent claim denials hurt more than just payers. Patients are frequently irritated when their claims are refused. Consider this: after visiting your doctor, wouldn’t you feel annoyed if you received a charge for services you thought to be covered? A practice with patients who have this difficulty frequently may lose those patients. Claim scrubbers once again cut the problem in the bud. Your patients will likely get the coverage they seek for your treatments as your claim denial rates decreases. When you exceed the patient’s expectations, they are much more likely to return. Your clinic will see more income faster with an accelerated claims procedure and patient retention.

Terms to Know About Claim-Scrubbing

Learn the meanings of these frequent claim-scrubbing terms.

Superbills:

These are itemized lists of services supplied to the patient and serve as the primary basis for creating claims.

CMS-1500 and UB-04:

The CMS-1500 and UB-04 medical documents are most commonly utilized for collecting patient case histories and billing claims.

Claim-editing software:

Claim-editing software is connected with electronic health records or practice management systems to guarantee that claims are billed at the exact contracted amount, coded correctly, and processed as rapidly as possible.

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