A well designed medical billing process does not allow errors to propagate. This design tenant results in less effort required to collect payments and payments arriving much faster. One of the most important manifestations of this concept is insuring that claims are clean before they are submitted to payers.
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.
- Core coding scrubber that compares the claim's coding to local Medicare and Correct Coding Initiative rules. Such a scrubber should not only identify negative issues (e.g., a diagnosis/procedure mismatch) but also improvement opportunities (e.g., this procedure is typically performed in conjunction with a second, billable procedure, that is missing from this claim).
The scrubbers outlined above are a basic service that any medical billing company should offer. Medical billing companies should also be able to utilize medical billing specific know-how and business intelligence created over time through work with many clients across specialties and geographies to create their own proprietary set of claim scrubbing rules. This third type of scrubber is a:
- Knowledge Management Scrubbers that allow the medical billing operation to continually reevaluate the adjudication rules of each payer and update the rules accordingly. The proper implementation of the scrubber requires a clear feedback loop from the follow-up department to the scrubber so that the lessons learned from denied claims can be quickly incorporated in to the scrubber. Any top notch medical billing service utilizes a scrubber like this.
Utilizing all of the scrubbers outlined in this article will dramatically lower days in AR and allow the billing staff to properly purse any issues that remain. In today's medical billing environment, use of these scrubbers is truly mandatory.
Copyright 2008 Carl Mays II - 15246
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.
- Core coding scrubber that compares the claim's coding to local Medicare and Correct Coding Initiative rules. Such a scrubber should not only identify negative issues (e.g., a diagnosis/procedure mismatch) but also improvement opportunities (e.g., this procedure is typically performed in conjunction with a second, billable procedure, that is missing from this claim).
The scrubbers outlined above are a basic service that any medical billing company should offer. Medical billing companies should also be able to utilize medical billing specific know-how and business intelligence created over time through work with many clients across specialties and geographies to create their own proprietary set of claim scrubbing rules. This third type of scrubber is a:
- Knowledge Management Scrubbers that allow the medical billing operation to continually reevaluate the adjudication rules of each payer and update the rules accordingly. The proper implementation of the scrubber requires a clear feedback loop from the follow-up department to the scrubber so that the lessons learned from denied claims can be quickly incorporated in to the scrubber. Any top notch medical billing service utilizes a scrubber like this.
Utilizing all of the scrubbers outlined in this article will dramatically lower days in AR and allow the billing staff to properly purse any issues that remain. In today's medical billing environment, use of these scrubbers is truly mandatory.
Copyright 2008 Carl Mays II - 15246
About the Author:
Carl Mays II, CEO of ClaimCare Medical Billing Services, has spent over 14 years improving the operations of his clients. To read more about selecting Healthcare Billing Services subscribe to Carl's blog
