If Your Healthcare Billing Service Using A Claim Scrubber?
One of the most important things in billing is to create and follow a very structured plan that can be measured each step of the way. Remember, if it cannot be measured and monitored it cannot be improved! One key element of this plan must be how to consistently and reliable create clean claims.
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 minimum requirements scrubber. Such a scrubber insures that the basic elements of the claims are in place (for example, a 9 digit social security number that is not composed of repeating numbers, a valid date of birth, 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:
- Customizable Rule Scrubber that applies the learnings from each denied claim to all future claims. This allows the rules to stay in step with the payers ever changing adjudication rules. Such scrubbers are the hallmark of the best medical billing services.
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