What Happens During Claim Scrubbing?

What Happens During Claim Scrubbing?
What Happens During Claim Scrubbing?

Claim scrubbing is a service offered by third parties to healthcare providers. Its primary purpose is to detect and eliminate errors in billing codes, reducing the number of claims to medical insurers that are denied or rejected. It is essentially a way of auditing claims before they are submitted to insurers.

The auditing process can vary in complexity. Some service providers will merely check that there is actual data in a required field, while others will extend the check to ensure that the data entered is accurate.

Claims Require Lots of Coded Information

The amount of information on any given claim is staggering. Claims must contain personal details about the patient, the healthcare provider, individual physicians and medical staff, as well as all diagnoses, procedures, treatments and tests that have been carried out. They also include details about the insurer.

In order to standardize the processing of claims, insurers use a defined set of codes. Codifying all the information accurately is essential if the claim is to be paid in a timely fashion—or paid at all.

Unfortunately, the complexity of the process leaves a large margin for error. There are more than 13,000 diagnosis codes and more than 3,000 procedure codes under ICD-9.1 Added to these are thousands more HCPCS and CPT codes. Claims must also be HIPAA compliant. To add to the complexity, codes are continuously updated, and there are countless combinations possible between them.2

Any inaccuracies will result in the claim being rejected. It can be frustrating when a simple error, such as entering the patient’s sex incorrectly, results in a long delay while the claim is corrected and then resubmitted.

Benefits of Using Claim Scrubbing Services

The principal benefit of using claim scrubbing services is a reduction in the quantity of rejected claims. That means improved cash flow, as invoices are reimbursed promptly. These services also reduce the labor overheads of a healthcare provider, since there will be less time and effort spent rectifying faulty claims.

Alternatives to Using Claim Scrubbing Services

The services provided by claims scrubbing businesses come at a cost. For that reason, many healthcare providers look for alternatives. The best alternative to claim scrubbing is to use a top-level electronic health record system that is updated in real time. The best EHR systems provide comprehensive support for the billing procedure. Users do not need to keep information about codes, as the codes are automatically provided by the system. As bills are entered, users simply select the raw information from built-in databases, and the system produces the correct code.

This vastly reduces the chances of an error being made in entering the details of a bill. It still requires care and attention to maintain accuracy, but nowhere near the same level of concentration as is required when doing billing manually.

Some EHR systems, such as that provided by Integrity Support, come with clearinghouse fees included as a benefit. This enables healthcare providers to benefit from claim scrubbing services with no additional overhead.

Businesses that help providers submit accurate claims provide an invaluable service. When that service is provided at no additional cost, providers can reap even more benefits.


References:

  1. https://www.cdc.gov/nchs/icd/icd10cm_pcs_background.htm
  2. https://www.cdc.gov/mmwr/preview/mmwrhtml/m2e411a1.htm