Generally defined, claims scrubbing involves finding and getting rid of errors that are found in billing codes. This is done in order to cut down on the overall number of rejected or denied claims submitted to insurance companies. In other words, this process helps to audit claims prior to them being submitted to insurers.
The auditing process varies significantly depending on how complex the claim is. There are some service providers who will only check that there is data in a specific field. However, other service providers will go beyond that in order to ensure that the data itself is actually accurate.
There is a lot of information found in a claim that can cause severe delays if incorrect. They generally include the following personal details:
- Patient information
- Healthcare provide
- Individual physician
- Medical staff
- Diagnoses
- Procedures
- Treatments
- Tests
- Insurer details
All insurers use a specific set of codes as a way to help with processing claims, and codifying everything as accurately as possible is extremely important in order for the claim to be paid on time.
Sometimes, however, there can often be a small margin for error, as there are over 13,000 diagnosis codes and over 3,000 procedure codes under ICD-9. Additionally, there are thousands more CPT and HCPCS codes as well. On top of all of that , all claims submitted must also be compliant with HIPAA regulations. Codes are also updated on a regular basis and can include all sorts of combinations between all of them. If there are any inaccuracies at all, the claim will be rejected.
Perhaps one of the biggest benefits of claims scrubbing is that the amount of rejected claims ends up getting reduced. As a result, there will be an increased amount of cash flow and a reduction in labor overheads for healthcare providers.
Claims scrubbing is a good investment as a preventative cost, but some providers avoid it without thinking of the larger long-term costs of denials. Because of this, there are some healthcare providers who will instead seek out other alternatives, such as an electronic health record system that can be updated in real time. Those who utilize these never have to keep any information regarding codes since the system itself automatically provides them. Once the bills are entered, all the user has to do from there is simply select information from the built-in databases. From there, the system will then produce the correct code, thereby reducing the chance of any error being made. Of course, attention and care are still required in order to help with maintaining a sense of accuracy, but it doesn’t require the same amount of caution with manual billing.
All in all, any business that is designed to assist providers with being able to submit claims that are accurate are truly invaluable. Even better is the fact that providers will be able to always take advantage of even more benefits whenever that same service is offered at no further cost.
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