Medical Billing Services Must Use Claim Scrubbers

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.

One of the best tools for insuring claims are clean before they are submitted is a claim scrubber. A claim scrubber takes the rules that payers use to adjudicate claims and applies them to the claims befroe they are ever submitted. This eliminates avoidable denials and thus speeds up collections. In addition, it frees up time in the billing process for staff to focus on activities that help increase collections instead of just correcting avoidable problems. Every Medical Billing Company should utilize at least the following scrubbers:

- 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).

- Core coding scrubber that compares the claim’s coding to local Medicare and Correct Coding Initiative rules. Such a scrubber should not only identify negative issues (e.g., a diagnosis/procedure mismatch) but also improvement opportunities (e.g., this procedure is typically performed in conjunction with a second, billable procedure, that is missing from this claim).

These two scrubbers are the bare minimum that any medical billing company needs to employ. The next level of scrubber is one that captures in a systematic and easily utilized manner the knowledge base that the medical billing service has developed over years of serving multiple clients, specialties and states. In order to do this, the medical billing company needs a scrubber that allows them to create their own rules:

- 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.

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

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