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:
- Basic mechanical scrubber. This scrubber assures that all claim fields have been properly filled with formatted data (social security number with 9 digits, date of birth etc), the NPI is in a proper field, there is a referring physician if needed, 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 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:
- 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 - 15266
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:
- Basic mechanical scrubber. This scrubber assures that all claim fields have been properly filled with formatted data (social security number with 9 digits, date of birth etc), the NPI is in a proper field, there is a referring physician if needed, 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 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:
- 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 - 15266
About the Author:
Carl Mays II, President of ClaimCare Medical Billing Services, has spent the past 15 years improving the financial performance of his clients. To read more about selecting Healthcare Billing Services see his other articles.
