All you need to Know about Claim Scrubbing in Medical Billing

Healthcare providers spend their lifetimes perfecting their craft and assisting patients to live more meaningful lives. However, in all those years of learning, they probably did not take training to process claims or even get payers/patients to pay their bills in full. When physicians and their practices lack the expertise and experience to fill out medical claims correctly, the insurance providers can end up rejecting those claims. With that begins a new back-and-forth process, which can cost your practice time and money. This is your clue to adopt claim scrubbing solutions. A wrong claim processing takes a massive bite out of your practice revenue, with one study suggesting the average cost of reworking a denied claim is $118. While medical billing services are a solution to all of this – today, let’s learn more about claims scrubbing, its importance, and some common terminologies.

Claim Scrubbing – an Overview

The process of scrubbing involves checking claims before submission to the payers. Doing so ensures that all claims are:

Accurate
Complete
Have correct codes

The claim-scrubbing process increases the chances that an insurer will pay each claim quickly. In the past, patient collection and claim scrubbing were tedious processes. In particular, the claims scrubbing was undertaken manually – in a long, tedious process, especially for larger practices.
But now, with the digitization of healthcare billing, more healthcare providers are spending on efficient claim scrubbing tools while partnering with third-party medical billing companies – to accelerate the process. Having the right solutions and tools in place, healthcare practices like yours can get the peace of mind that comes with knowing that their reimbursements will be faster and complete and that every claim filed for their services is accurate.

Importance of Claim Scrubbing in Medical Billing

Claims scrubbing has numerous benefits for healthcare providers and insurance companies. Some of these benefits are:

1. Error-free Claims Submission

The major benefit of claim-scrubbing is its results, which increase the accuracy of insurance claim submissions. The more often your claim submissions are accurate, the fewer denials there will be. Consequently, you will encounter fewer and fewer obstacles in getting timely and complete reimbursements from insurance companies.

2. Faster Reimbursements

Claim denials can affect the reimbursement process and delay the payment process. However, with a strong claim scrubbing process, your practice is far more likely to submit clean and accurate claims right on the first try. This leads insurance providers to make timely payments for your care services. The claims scrubbing process increases the RCM cash flow, which your practice can use to meet its needs.

3. Improving Payer Relationships

For all healthcare practices, the insurance payers and carriers are the primary sources of revenue. That being said, it is understandable that the claims scrubbing process leads to a massive reduction in faulty claims in your practice files. All of which helps you form better relationships with the payers. Efficient claim scrubbing practices can help you build your case while connecting with new insurers to broaden your network.

4. Forming Patient Relationships

Recurring claim denials affect the insurance payers, and patients get annoyed when claims are denied.
Consider this: after going to your doctor and going through treatments, wouldn’t you be annoyed if you received a bill for services you expected to be covered? A healthcare practice whose patient regularly experience such instances risks losing their clientele.
Claim-scrubbing lowers the risks of claim denials, and your patients will be more likely to get the coverage they expect for your services. When your practice meets patient expectations, they are more likely to become your returning customers. Thus, between patient retention and the accelerated claims process, your healthcare practice will be looking at more practice revenue, that too, more quickly.

5. Decreasing Claim Rejections

After a healthcare provider performs a service, they must file a claim for reimbursement. Claim filings can become complex and rather tricky, coming along with a wider margin for errors. Therefore, the claim-scrubbing services can help your practice remove errors from the claims before they are filed.

6. Reducing Claims Review Time

Claim submission is a tricky and time-consuming process; therefore, employing a claim scrubber ensures that you spend as little time as possible reviewing your claims for any possible errors.

Popular Terms to Know for Claim Scrubbing

Below are some essential terms you must know to round off your knowledge on the topic.

1. Superbills

Superbills outline the services provided to a patient, with the time of services recorded. This document is used to inform what goes into the claim.

2. Claim Forms

The claim form is another essential document determining why an insurance payer should pay a healthcare practice or an individual. The data on a claim form also comes from a superbill.

3. Claims Editing

The process of claim editing and reviews identifies claim errors and then puts the correct information on a form before sending it to an insurance provider. This process ensures that all claims get reimbursed faster.

4. Charge Review

Inside the charge review process, healthcare practices compare their rates to the standard rates put forward by health insurers like Medicaid or Medicare.

5. Coding Errors

When faulty or wrong information is entered on a claim form, this results in coding errors. Such errors often become a reason for claim denials, which frustrate patients and providers while also stifling the practice’s cash flow.

Benefits of Claim Scrubbing Services

Now that you have a better idea of what claim scrubbing is, let’s explore some of its main benefits. These benefits are the reasons your practice must consider for improving the overall billing and reimbursement process. The major benefits include:

1. Quicker Payments

The claims scrubbing process speeds up overall payment and reimbursement instances. It is done by improving the accuracy and completeness of the claims your practice submits. By reducing the number of claim rejections, your practice can get faster reimbursements.

2. Improved Cash Flow

Along with the faster cash flow, your practice’s overall revenue improves. This boosts cash flow, making it much easier to cover up the operating expenses, and also lets you invest in other core areas of your medical practice.

3. Happy Patients

By ensuring that each claim you submit is accurate and timely, the claim-scrubbing process leads to happy patients. Satisfied patients are more likely to trust you over the years and return to you for continued treatment.

4. Improved Productivity

As the claims scrubbing tools and services help healthcare practices with faster processes and as the scrubbed claims are less likely to be denied or rejected, the investment in claim scrubbing services enhances your overall RCM efficiency.
As opposed to spending long hours manually scrubbing claims or resubmitting rejected claims, your team can focus on more important aspects of your business.

Who offers claim scrubbing in healthcare?

Third-party medical billing companies usually offer claim scrubbing services. These companies employ skilled professionals in medical billing and claim submission processes. Such companies also employ and use automated tools for increased efficiency and compliance.

Conclusion

The claim processing in the healthcare industry is increasingly complex owing to multiple factors. The ever-changing regulatory requirements, the changing payer policies/guidelines, and the recent advancements in medical technology contribute to this complexity. The new codes and guidelines, like ICD-10, require thorough documentation and claim accuracy. The insurance providers also implement strict scrutiny policies, leading to increasing numbers of claim denials and appeals. Moreover, the rising values-based care models and the complex reimbursement structures further add complexity to claims filing processes. This is where claim scrubbing services come into play. Healthcare providers must stay updated, invest in new tools, and consider delegating the billing processing tasks to experienced professionals – who can fully understand and manage the complexities of claims processing.