Scrub You Claims Before Your Submit Them

A well designed medical billing process does not allow errors to propagate. This design tenant results in less effort required to collect payments and payments arriving much faster. One of the most important manifestations of this concept is insuring that claims are clean before they are submitted to payers.

Clean claim submission can reduce average days in AR to less than 45 days

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 baseline scrubber. This scrubber insures that the claim has at least the basic information such as a social security number, properly formatted insurance id number, etc.

- Coding and Diagnosis Scrubber. This scrubber looks for ICD-9/CPT mismatches based upon Medicare and CCI rules. The rules not only identify sources of denials, but also identify overlooked CPTs.

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:

- Dynamic Proprietary Rule scrubber that checks for optimal coding and documentation versus each particular payer or plan’s rules. This scrub assures that each claim is optimized for clean submission. When the payer or plan’s rules change or when the billing office detects a systemic issue they should update the scrubber to filter and fix problems before claims are submitted. These specialized scrubbers differentiate the Tier one medical billing companies from the rest of the crowd and can make a significant collections difference.

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

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