If Your Healthcare Billing Service Using A Claim Scrubber?
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 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.
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.
Utilizing all of the scrubbers outlined in this article will dramatically lower days in AR and allow the billing staff to properly purse any issues that remain. In today’s medical billing environment, use of these scrubbers is truly mandatory.
Copyright 2008 Carl Mays II
Filed under: Outsourcing