In this IT centric healthcare world we now live in, claim scrubbing is a true “no brainer”.  Most practices spend thousands of dollars on IT tools yet fail to take advantage of perhaps the most useful billing tool, a true front-end claim scrubber.  Front-end being prior to AR.  Many practice management software programs have some sort of claim scrubber included in their packages, but they are not true front-end and they do not optimize what should be the “no brainer” part of it all.

Claim scrubbing to be truly achieved should contain the edits of all the major carriers of your practice.  Daily batches of charges run against these rules can be quickly scrubbed for carrier edits preventing denials.  Getting the claims cleanly through the system to the carrier is the goal of claim scrubbing.  Quite simply, a “clean” claim is one that satisfies all the carrier rules for payment.  The primary advantage is quicker turnaround on cash.  And isn’t that the point?

Claim Scrubbing will achieve 4 advantages over claims not scrubbed:

1. Maximize first time payment
2. Validate 837 files for every payor
3. Access extensive database to properly identify problems and errors on claims
4. Ensure HIPAA compliance for all your claims

The initial investment in a front-end editing tool will pay for itself quickly as denials quickly decrease and cash flow becomes more predictable. It is the single most cost effective way a practice can change the outcome of billing.

Medical billing is a complex, ever-changing industry, and the amount of information that a typical billing claim contains is almost staggering. Between patient information, insurer information, provider information and physician information, there’s tremendous room for error. By taking the guess work out of this process and running claims through a scrubber, your practice can achieve highly efficient billing that is cost-effective and cash generating.

How to implement a claims scrubber must be carefully evaluated by each practice.  Does the scrubber have the capacity to build your own rules?  Are you getting regular updates to carrier based rules? Is someone knowledgeable correcting the claims with errors?  What is the most efficient work flow for your practice?  Are proper balancing procedures in place to ensure all batches released into practice management system?  Are there checks and balances to the process?  Is IT involved in the care of the software/hardware?

Like any software, the practice must invest time and energy in learning the software….and then tweaking the process over time to ensure real effectiveness.  A baseline of denials by category should be run prior to implementation and progress demonstrated monthly.  Having the tool does not guarantee success, using the tool properly does.