Submitting clean claims is critical to a strong medical billing process. A fundamental element of good process design is to catch problems as soon in the process as you can. Correcting a diagnosis error before a claim is submitted may take 5 minutes; correcting it after the claim has been denied will take well over an hour (and it will delay collections by 3o or more days).
Implementing a process that submits clean claims can lead to days in AR of less than 45.
The leading medical billing services utilize scrubbers that ensure your claims are clean before they are submitted to payers. These scrubs accelerate the speed of collections by avoiding denials and delays. They also increase collections by minimizing the volume of “re-work” and allowing billing staff to focus their efforts on pursuing true collections improvement opportunities and not simply resubmitting claims that should have been paid the first time. As a result of these scrubbers, over 90% of claims submitted are paid upon first submission. These “scrubbers” include:
– 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.
– Coding and Diagnosis Scrubber. This scrubber looks for ICD-9/CPT mismatches based upon Medicare and CCI rules. The rules not only identify sources of denials, but also identify overlooked CPTs.
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:
– Dynamic Proprietary Rule scrubber that checks for optimal coding and documentation versus each particular payer or plan’s rules. This scrub assures that each claim is optimized for clean submission. When the payer or plan’s rules change or when the billing office detects a systemic issue they should update the scrubber to filter and fix problems before claims are submitted. These specialized scrubbers differentiate the Tier one medical billing companies from the rest of the crowd and can make a significant collections difference.
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
Author: Carl Mays IIThis author has published 6 articles so far.