Claims scrubbing is the process of inspecting your practice’s medical claims for errors, and as a result, payers (such as health insurers) may deny the claim. Claim scrubbers, whether humans or computer programs, check the Current Procedural Terminology (CPT) codes on your claims.
Third-party claims scrubbing is a service provided to healthcare providers by third parties. Its primary goal is to detect and eliminate billing code errors, reducing the number of denied or rejected claims to medical insurers. It is essentially a method of auditing claims prior to submission to insurers.
The complexity of the auditing process can vary. For example, some service providers will verify that there is data in a required field, whereas others will go the extra mile to ensure that the data entered is correct.
If your practice continues to submit claims, in the same manner, it has for a long time, you are almost undoubtedly whether spending a lot of time scrubbing claims or dealing with more rejected claims than you would like. However, you can rest assured that most of your claims will be paid on time by making smart choices in practice software applications and collaborating with expert teams.
You can speed up payments and ensure your practice has the cash it needs to continue treating patients effectively by modernizing your practice’s approach to claims scrubbing.
Claims scrubbing is important at the highest level because it allows practices to gain more authority over their cash flow and accelerate payments by lowering the likelihood of errors being sent to insurance companies.
Furthermore, claims scrubbing relieves employees of the burden of reviewing rejected claims. Certainly, suppose your training invests in technological resources to speed up the process. In that case, your team will save significant time by reviewing claims before submission and investing in other critical areas of practice operations.
Instead of spending hours each week dealing with claims scrubbing, staff can focus more on delivering patient-centric care, which improves the patient experience, reduces churn, and boosts your bottom line.
Negative Repercussions Of Failure To Scrub Claim Before Submission Date
- Delays in Payment
The more claims that are rejected, the longer it takes for your organization to receive payment. Assume you waited until the end of the day to send everything to your client’s payers. It’s been a long day of nothing but physicals, and you’re already late for a family event. As a result, you gloss over each claim, hit submit, and then go about your business.
Three days later, you receive payer rejections for every claim you submitted that day because you were one digit off the CPT code for all of them. This is a good time to point out that one day’s worth of claims is a lot, but it’s not overwhelming. Every day, you receive many payer rejections because you cannot produce a clean.
You won’t be able to keep up if you’re dealing with a new tidal wave of rejections every day. Payment delays are one of the side effects. Of course, you could hire an army of medical billers. However, this comes at a cost.
- Claim Rejections by the Truckload
If you don’t scrub your claims before submitting them, you’ll have many more claim rejections. Front-end denials occur because claims are not scrubbed. Although that is true, your clearinghouse should be on your side before you submit to a payer and receive a denial.
If you don’t feel comfortable about your clearinghouse, you should consider switching to a different one. Anyway, I’m trying to make the point that your clearinghouse should scrub your claims automatically. If the clearinghouse discovers errors in your submission, it should reject it on its own.
Obtaining claim rejections at the clearinghouse level is not the end of the world; in fact, they are preferable to payer-level rejections. To put it into perspective, it takes the payer 1 – 3 days to reject a claim, a time most healthcare organizations do not have readily available.
- Increase in Employment Stress and Burnout
Sometimes the healthcare industry is overworked. Burnout rates are so high that many healthcare professionals decide to leave the industry entirely.
Of course, there are numerous reasons for the high burnout rate in this industry. However, much of it is due to the physician shortage across the world. The point I’m attempting to make is twofold. The first is that if most healthcare organizations are experiencing a staffing crisis, yours is also. Second, a shortage of medical professionals is driving burnout rates because facilities lack adequate bandwidth.
So, if you’re not scrubbing claims before submission, you will have a lot more rework. Furthermore, your bottom line will be reduced. The icing on the cake is that your team, which is already overworked based on industry trends, will be given additional daily responsibilities to manage.
- Revenue Decline
Perhaps your mindset is that you’ll submit what you can, and whatever is rejected by players will be added to a never-ending to-do list of claims that need to be reconfigured. Although that seems reasonable, it is not achievable.
You may already be aware that insurance companies impose deadlines for filing claims. In other words, it will be denied if you don’t submit or resubmit a claim to a payer within the time frame specified. Yet, surprisingly, you’ll hear back from a payer within 1 – 4 weeks whether or not your claim was denied.
So, if you keep a stack of rejections around, you might as well consider them denials at this point. But, unfortunately, the industry trend for collecting on denials is also not in your favor. Healthcare organizations are now writing off 90% more claim denials than six years ago.
As I mentioned in the previous section, receiving many payer rejections causes payment delays due to the time it takes to clean them. Meanwhile, failing to resolve those rejected claims quickly enough results in denials.
- Discontented Patients
It’s easy to lose sight of the purpose of medical facilities when dealing with insurance payers on the revenue cycle side of healthcare. Most professionals enter the industry intending to care for patients. Unfortunately, failing to scrub your claims may impact the patients seeking services from your facility.
Consider the following. Your team will not have time to see your patients if they are too preoccupied with staying on top of ignored claims to avoid denials. They’ll be so focused on the mountain of work they have to do during those inevitable patient interactions.
You’ve probably planned everything from greeting patients to signing them out to ensure an exceptional patient experience. But, unfortunately, that can’t happen in an alternate universe where your company isn’t scrubbing claims.
If you have a clearinghouse, it should “have your back” by scrubbing and rejecting claims before submitting them to payers. Although it is technically coming from your clearinghouse, it is still a rejection that you will have to rework. On the other hand, clearinghouse rejections exist as a safeguard in the process and occur in real-time.
Rather than queuing up for the payer to ignore your claim, you can clean it as soon as your depository sends you an instant notification. Of course, it still takes work, but it’s a much better and more efficient option than losing yearly money.
However, the best option is to use Practice Management System(PMS) that scrubs your claims before submission.
Automated Claims Scrubbing
For many years, medical professionals had to manually review each claim before submitting it to the insurance companies. Some medical providers still process claims this way, but most have switched to electronic billing services. In addition, some companies can perform automatic claims scrubbing to relieve medical providers of the need to scrub claims manually.
The companies act as a go-between for practices and insurance companies, making medical billing easier for everyone. Before being sent to an insurance company, the claim is run through software that checks for any errors or inaccuracies. Electronic claims scrubbing saves time and prevents medical practices from devoting valuable workforce to tedious and meticulous tasks like reviewing medical claims information. In addition, it ensures that medical professionals are not distracted by the technicalities of claims processing and can devote their time to the most important aspect of the healthcare system: the patients.
The Role of Coding in the Medical Claims Process
The information that must be included on a claim is extensive because the insurance company needs to fully understand the situation before deciding whether to accept or deny the claim. The medical billing community heavily relies on coding to make the process faster and easier. Using codes saves professionals time by eliminating the need to write out every detail for each patient. Explicitly clarifying each set of content wastes time and prevents medical professionals from paying attention to the patient. Instead, they can use a single set of numbers instead of writing out the diagnosis or type of treatment, and the insurance company will understand the situation. In addition, it makes the process more consistent.
The disadvantage of using codes is that it introduces a significant margin for error. All it takes is one incorrect number to cause the insurance company to deny the entire claim. The medical community employs over 13,000 diagnosis codes and 3,000 procedure codes. There are thousands of HCPCS and CPT codes in addition to diagnosis and procedure codes. All claims must also follow HIPAA rules and regulations. All codes are constantly changed and updated to increase the possibility of errors.
The number of medical code combinations is overwhelming, and as a result, there is a high likelihood that an error will occur with the code. If this occurs, the insurance company may deny the entire claim, requiring the process to be restarted and requiring even more time and effort.
The high margin of error in coding emphasizes the significance of claims scrubbing. People do not have the time or focus to thoroughly review each claim, especially given the daily volume of claims submitted to insurance companies. Before submitting the claim, effective claims scrubbing will define any coding errors, providing the opportunity to correct the error. Correcting a mistake before sending the claim takes far less time than submitting a claim, waiting for the insurance company to decide, and reviewing the claim after it has been returned.