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.
If claims are indeed submitted clean, then over 90% can be paid after the first submission. This leaves a much smaller number of “real” issues for the medical billing staff to pursue. By eliminating avoidable errors, collections accelerate and increase (since in many billing offices there is no time to perform basic tasks like no response calls). A key tool in realizing these improvements is a claim scrubber. These scrubbers, which are used by all leading medical billing services, compare claims to the rules utilized by payers to decide if a claim will be paid. These scrubbers include:
- A Basic Demographic scrubber. Such a scrubber insures that the basic elements of the claims are in place (for example, a 9 digit social security number that is not composed of repeating numbers, a valid date of birth, 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:
- 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.
Medical Practices will see a significant improvement in both the speed and the magnitude of collections if the begin using the scrubbers outlined above. With all of the technology payers employ to minimize the amount they pay to providers, it is difficult to survive without utilizing these scrubbers.
Copyright 2008 Carl Mays II