What is the Significance of Claims Scrubbing in Medical Billing? Proven Ways to Improve Claims Scrubbing
 Revenue Cycle Management

What is the Significance of Claims Scrubbing in Medical Billing? Proven Ways to Improve Claims Scrubbing

Janet Scott
Janet Scott
July 18, 2023
Last updated on:

July 18, 2023

|

Read time: 4 mins

Claims scrubbing in medical billing refers to the process of electronically reviewing and validating healthcare claims before they are submitted to insurance payers for reimbursement. It involves running the claims through automated software or systems that identify and flag errors, inconsistencies, or missing information that could potentially lead to claim denials or delays in payment. Any discrepancies found during scrubbing are flagged for correction, enabling providers to address issues proactively and resubmit clean claims. Implementing claim scrubbing as a part of the medical billing process is a proactive approach to RCM.

In this blog, we will delve into the importance of claims processing and how to implement it in medical claims processing effectively.

Common Claim Scrubbing Terms You Should Know: Superbills: Superbills are the itemized lists of services provided to the patient; they’re the primary source used for creating claims.

CMS-1500 and UB-04: CMS-1500 and UB-04 are the most common medical forms used for compiling patient case history and billing claims.

Claim-editing tools: Claim-editing tools, or claim-scrubbing software, are integrated with electronic health records or practice management systems to ensure that claims are billed at the actual contracted amount, coded accurately, and processed as quickly as possible.

Charge review rules engines: Charge review rules engines review, correct, and apply millions of coding rules to submitted claims to ensure billing accuracy.

The Significance of Claims Scrubbing in Medical Billing

Claims scrubbing is important because it offers the following benefits: 

Error Prevention

Claims scrubbing helps identify and rectify errors, such as missing or incorrect patient information, incorrect coding, or incomplete documentation before claims are submitted. By catching these errors early on, providers can reduce the chances of claim denials and delays, ultimately increasing revenue cycle productivity through effective medical billing services

Increased Efficiency

Scrubbing claims before submission ensures that they meet the specific requirements of different payers. This helps minimize rework and resubmissions and saves time and effort for both the healthcare provider and the insurance payer. It also streamlines the billing process and accelerates reimbursement timelines.

Compliance with Payer Rules

Different insurance payers have specific rules and guidelines that must be followed when submitting claims. Claims scrubbing ensures that the claims adhere to these rules, preventing potential non-compliance issues. This includes checking for correct coding, modifier usage, and medical necessity documentation.

Reduced Claim Denials

By identifying and addressing errors or inconsistencies, claims scrubbing significantly reduces the risk of claim denials. It helps ensure that claims are accurate, complete, and meet the specific requirements of insurance payers. This leads to a higher rate of clean claims, increasing the likelihood of timely and accurate reimbursement.

Financial Optimization

Effective claims scrubbing results in higher first-pass acceptance rates, reducing the need for costly and time-consuming appeals or rework. It maximizes revenue by minimizing denials and payment delays, improving cash flow and overall financial performance for healthcare providers.

Regulatory Compliance

Claims scrubbing also plays a key role in ensuring compliance with regulatory requirements, including HIPAA, by verifying that patient information and documentation are appropriately handled and protected.

What are the functions of claim scrubbing software?
Claim scrubbing software automates the review of medical claims to identify errors, missing data, and non-compliance issues. It ensures accurate and clean claims before submission, reducing denials, improving reimbursement rates, and streamlining revenue cycle management for healthcare providers.

Significance of Claim Scrubbing in Medical Billing
Image 1 - Significance of Claim Scrubbing in Medical Billing

How to Improve Claims Scrubbing Process?

Healthcare providers can enhance the claim scrubbing process in several ways:

Implement Robust Software

Investing in advanced claims scrubbing software helps healthcare providers streamline the process and improve accuracy. These tools utilize automated algorithms to detect errors and inconsistencies, ensuring claims are clean before submission.

Conduct Ongoing Staff Training

Regular training sessions for billing and coding staff help practices stay updated with the latest coding guidelines and payer requirements. Well-trained staff are more equipped to identify potential errors and resolve issues during the claim scrubbing process.

Perform Internal Audits

Conducting internal audits of the claim scrubbing process allows providers to identify patterns of errors, areas of improvement, and training needs. This feedback loop helps refine the process and ensure ongoing accuracy and compliance.

Collaborate with Payers

Building strong relationships with insurance payers can help healthcare providers gain insights into payer-specific requirements. Also, regular communication and feedback exchanges can minimize claim rejections and denials.

Ways to Improve Claim Scrubbing Process
Image 2 - Ways to Improve Claim Scrubbing Process

Conclusion

Claim processing in the healthcare industry is becoming increasingly complex due to various factors. Evolving regulatory requirements, changing payer policies, and advancements in medical technology contribute to the growing complexity. New codes and guidelines, such as ICD-10, require meticulous documentation and coding accuracy. 

Even payers implement stricter scrutiny, which leads to increased claim denials and appeals. Additionally, the rise in value-based care models and complex reimbursement structures adds further intricacy to the process. To navigate this complexity, healthcare providers must stay updated, invest in robust technology, and consider delegating the task to experienced professionals who can handle the intricacies of claims processing efficiently.

Invensis has over 22 years of experience in providing claims scrubbing support services to healthcare providers. We provide access to specialized expertise, scalable resources, and improved efficiency. It allows healthcare providers to focus on core patient care while ensuring that their claim scrubbing process is handled by professionals with in-depth knowledge of payer requirements and industry best practices. Get in touch with us to know more about our services. 

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