For starters, one needs to understand what claim scrubbing entails to grasp how it impacts your finances. Essentially, claim scrubbing refers to an automatic auditing process where each claim is audited using thousands of rules before being passed on to the clearinghouse or payer.
With today’s billing system having switched from manual verification to rules-based software verification, some of the mistakes detected by such rules-based software include missing ICD-10 codes, conflicting CPT codes, unbundling, double billing, and missing patient information.
As a result, billers can spot these issues and fix them right in the system. Ultimately, the goal is a high first-pass clean claim rate. In other words, the claim gets paid the first time, with no edits needed.
Why Claim Scrubbing Matters
Sending claims straight to insurers like Medicare and Medicaid can be risky. For instance, they use strict, automated filters. As a result, any formatting error gets an instant rejection.
A strict pre-submission check matters for these reasons:
- Reduction of Claim Denial Rate: Claim denials waste time and money. For example, common causes are missing modifiers and wrong insurance data. If no one catches these early, the claim gets rejected.
- Shorter Days in A/R: Payers process clean claims fast. As a result, this shortens your Days in Accounts Receivable. For instance, a clean claim can get paid in 10 to 14 days. In contrast, a reworked claim can take 45 to 90 days to resubmit.
- Fewer Administrative Costs: Reworking a denied claim can cost $25 to $118 per claim. In addition, avoiding that first denial saves time spent verifying claims, fighting denials, and resubmitting them.
- Protected Revenue: Insurers set strict deadlines for filing claims. Over time, months of denials and appeals can eat up that deadline, and you lose the revenue for good. Therefore, scrubbing claims avoids these delays and keeps you well within payer deadlines.
Common Audit Errors
Rules change all the time, and even a skilled biller can make mistakes. As a result, automated claims scrubbing acts as a safety net. Specifically, it checks common claim types across several categories.
Coding & Modifier Mismatches
Medical coding is a constantly evolving profession. For example, the ICD-10 should be able to be used with the CPT/HCPCS codes in use on the claim. Scrubbing software, then, will be used to check compatibility to ensure compliance with medical necessity guidelines. Furthermore, it will recognize any missing/modified CPT modifiers like 25, 59, etc.
Demographic & Eligibility Errors
The initial denials usually arise due to administrative mistakes rather than health care-related problems. In particular, the pre-denial reviews search for the important information about the patient, including:
- The correct name and date of birth of the insured person.
- An active insurance policy number and group code.
- Correct routing details for the primary, secondary, or third payer.
- The right provider numbers and billing location NPIs.
Key Benefits
Automated claim scrubbing brings many benefits across your whole revenue cycle:
Billing rules change often, as regional carriers, CMS, and private insurers update them. As a result, scrubbing platforms update their rules automatically. Therefore, staff doesn’t have to track thousands of weekly changes. Overall, this keeps your billing on the right side of the rules.
- High First-Pass Percentages: One of the objectives is to attain a first-pass clean claims percentage of 95 percent or higher. Due to this, the scrubbing process is able to identify any mistakes even before submitting the claims.
- Predictable Finances: Due to claims being processed well and without many disruptions, finances remain predictable. As a result, practice managers can forecast monthly income with real accuracy.
- Less Strain on Billing Staff: A backlog of denied claims wears down staff morale. In turn, scrubbing removes the need for repetitive claim checks, so staff can then focus on complex appeals instead.
Impact on Patient Satisfaction
Claim scrubbing helps your finances, but it also affects patients. For example, errors in the process can lead to surprise balance bills.
When claims are scrubbed and processed smoothly:
- EOB Accuracy: Patients receive clear cost information without having to contend with confusing denial letters.
- Patient Bills on Time: A denied claim may delay the receipt of patient bills by months.
- Stronger Trust: Billing mistakes erode patient trust. As a result, patients spend hours on the phone sorting out cost differences with their doctor’s office and insurer. In turn, smooth billing builds more faith in your practice.
Partnering with MIU
Building an in-house billing system takes real money and ongoing training. Specifically, it needs strong scrubbing tools, up-to-date clearinghouse links, and an independent auditing team. For many practices, outsourcing to a revenue cycle partner is the smarter move.
At MIU, we’ve built a streamlined, end-to-end approach to medical billing. Our focus is making your billing more accurate and helping your practice grow. As a result, this approach helps your claims pass pre-submission checks the first time.
Here are our core billing and auditing features:
- Automated Pre-Verification: We perform verification for any coding or demographic mistakes before submission of claims.
- Revenue Cycle Management: We perform all aspects of Revenue Cycle Management. This involves eligibility checking, front desk, coding, and Accounts Receivable.
- Claim Denial Solution: If the claim is denied for any reason, we will find out why it was denied, sort it out, and resubmit the claim.
- Clearinghouse Connectivity & Reporting: Good connectivity and great reporting can make it easy to monitor KPIs of your practice.
Thanks to MIU Medical Billing, you can rest assured that you will not be stressing about any insurance codes and rules. We strive to secure maximum payment for you. Consequently, you will have enough time to take care of your patients.
Final Thoughts
Pre-submission claim review is no longer optional. It’s a must for survival in today’s economy. In fact, claim scrubbing matters more than almost anything else for accuracy before submission.
Automated claim audits make your practice more efficient and keep you fully within the rules. Whether you use software or a trusted partner like MIU, money spent on pre-submission review is money well spent. Either way, it protects your bottom line.
