Medical billing can be a complicated process. The smallest of errors can lead to denied claims and a whole lot of lost time. The State of Claims 2022 report from Experian Health states that healthcare claim denials are a recurring issue for healthcare providers.
According to up to 75% of survey participants, claims are rejected between 5% and 15% of the time. About 33% of claims were rejected 10% to 15% of the time.
Claims management is now more crucial than before the pandemic, according to 72% of respondents. This is why healthcare organizations usually outsource medical billing to avoid denied claims or lost revenue.
Revenue Cycle Management (RCM) solutions contain claim scrubbers. Claim scrubbing is crucial to check for errors in claims before submitting them to payers. It results in faster payment.
Therefore, in this article, we will discover what claim scrubbing is, what the process entails, and its benefits.
What is Claim Scrubbing?
Claim scrubbing is the process of checking your medical claims for mistakes that can cause insurance companies to deny your claim.
Claim scrubbers check your claims’ Current Procedural Terminology (CPT) codes because even a small error in the applicable five-digit code can result in claim rejection.
Third-party medical billing or software businesses include claim scrubbing in their list of medical billing services. A medical software business uses automated rule engines to find any flaws that could result in claim denial. Claim scrubbers check the claims for issues after they have been created.
A medical biller or coder manually corrects the claim after finding any mistakes. Claims will probably be accepted if the biller or coder adheres to the claim scrubber’s detailed instructions.
Claim scrubbing technology can spot problems more accurately and quickly than people. They help you achieve cleaner claims and a higher first-pass yield.
The most common errors caught by claim scrubbers are:
- Invalid CPT code for date of service
- Lack of diagnosis code in a procedure
- Invalid diagnosis code
- Incorrect/invalid member ID
- Lack of admission date on an inpatient claim
- Coverage inactive on the date of service
- Upcoding, undercoding, bundling, inappropriate modifier usage, using unlisted codes without supporting documentation, and neglecting to check that claims comply with the National Correct Coding Initiative (NCCI).
Benefits of Scrubbing in Revenue Cycle Management
Claim scrubbing has revolutionized the revenue cycle process. It’s now playing a crucial role to benefit revenue cycle management. The benefits of claim scrubbing include the following:
Correct Claims
Claim scrubbing helps in producing accurate claims. Fewer claim denials result from frequently accurate claims. Fewer denials will be given to you the more your claims are correct, ultimately helping you simply payment collection.
Faster Payments
Denied claims usually result in the payment process being slowed down and terminated. Receiving acceptance of the claims ensures a steady cash flow.
You can get your claims accepted with the use of claim scrubbers. They improve claim accuracy, encouraging payers to pay the whole amount simultaneously. This increases reimbursements and boosts practice profitability.
Improved Patient Care
When you manually scan your claims, the procedure is labor-intensive and prone to inaccuracy. With the help of an automated claim scrubber, the process is done more swiftly and effectively. As a result, there is more time for staff and providers to contact and care for patients.
Improved Payer Relationships
Denied and repeatedly submitted claims cause the patient-provider relationship to suffer. Moreover, each payer has their own rules for claim submission, and it is possible that they would quit cooperating with the practice.
The use of claim scrubbers helps keep the payers happy. They improve your connections with your payers by significantly lowering the number of incorrect claims you submit.
When contacting new insurers to expand your network, you can use efficient claim-scrubbing techniques to strengthen your case. As a result, it would help retain older payers and bring in new ones.
Better Patient Relationships
Denied claims not only disturb the payers, but also pose a threat to the patient-provider relationship. If the issue persists, it will be challenging for the practice to keep its patients for an extended period.
Claim scrubbers can assist in resolving this problem. They lower the number of claim denials, which benefits the practice by increasing patient satisfaction and improving patient flow. Patients’ expectations are met, and patient retention results in a better revenue cycle.
Conclusion
Claims are the root of all billing troubles. Claim scrubbers can help address these issues by reducing the number of errors that occur with manual claim submission. With accepted claims, the revenue of the practice also increases. Thus, it becomes crucial for a medical billing practice to automate claim submission with revenue cycle management software with claim scrubbing.
An efficient revenue cycle management software, like CareCloud’s, can increase cash flow and guarantee the practice’s profitability by taking on the billing procedure.
