Don’t leave money on the table – use a claims scrubber

A well-designed medical billing process does not allow errors to spread. This tenant design translates to less effort required to collect payments and payments come in much faster. One of the most important manifestations of this concept is ensuring that claims are clean before they are presented to payers.

Implementing a process that submits clean claims can take AR days of less than 45.

If claims are submitted smoothly, more than 90% can be paid after the first submission. This leaves far fewer “real” problems for medical billing staff. By eliminating avoidable errors, collections are accelerated and increased (since in many billing offices there is no time to perform basic tasks such as no-answer calls). A key tool for making these improvements is a claims scrubber. These scrubbers, which are used by all major medical billing services, compare claims against the rules used by payers to decide whether a claim will be paid. These debuggers include:

• A basic demographic scrubber. Such a scrubber ensures that the basic elements of claims are in place (for example, a 9-digit social security number that is not made up of repeating numbers, a valid date of birth, etc.),
• Coding and diagnostic debugger. This debugger looks for ICD-9 / CPT mismatches according to Medicare and CCI rules. The rules not only identify the sources of denials, they also identify overlooked CPTs.

These debuggers will lead to a marked improvement compared to a billing process without debugging; however, they are not a complete scrubbing solution. A complete solution requires a debugger that can have a custom set of rules that takes the knowledge of the billing company or medical practices and codes it so that it can be applied to each claim before it is submitted. This debugger is:

• Knowledge management scrubbers that enable the medical billing operation to continually reevaluate the award rules for each payment and update the rules accordingly. Proper debugger implementation requires a clear feedback loop from the tracking department to the debugger so that lessons learned from denied claims can be quickly fed into the debugger. Any top-tier medical billing service uses a scrubber like this.

Medical practices will see a significant improvement in both the speed and magnitude of collections if they start using the scrubbers described above. With all the technology that payers use to minimize the amount they pay providers, it is difficult to survive without using these scrubbers.

Copyright 2008 Carl Mays II