In 2024, denial rates rose to 11.8%. Surpassing the previous rate of 10.2% in 2020. Medical billing can be confusing. Not only for the patients who have to navigate through it, but for billers as well. The landscape is constantly evolving, which makes keeping your clean claim rate high a true challenge.
Medical coding professionals help physicians collect on reimbursement for services provided. Whether that be through a payer or straight from the patient's pocket. Medical billing software continues to evolve, but there are even more tools that help streamline workflow.
If you are a medical billing professional, you know just how important having a clearinghouse to check your claims is. They offer tools such as claim scrubbers to double-check your billing and coding work in real-time.
Today, we will get into exactly what claim scrubbing software is. As well as how they help improve cash flow, and what to look for when choosing the right solution for your company! Let's take a look together.
What is A Claim Scrubber?
A claim scrubber is a specialty tool that checks your claim forms for any mistakes. These mistakes can look like:
An incorrect Current Procedural Terminology (CPT) code.
Incorrect ICD-10 codes or HCPCS codes.
Missing patient information.
Incorrect or missing insurance information.
This automation flags any errors so that your team can quickly edit and rework them. These mistakes may look different, depending on payer-specific rules. So having a tool to cross-check all claims for any billing errors is vital.
What is Claim Scrubbing in Medical Billing?
Claims scrubbing in medical billing is the process of finding errors in claims before sending them off to a payer for reimbursement.
This way, you won't have to wait days or even sometimes weeks to hear back about a submitted claim.
Introducing a clearinghouse to scrub your claims as an in between step saves you time and money.
Reduce Denials, Improve Claim Accuracy & Workflow
Claims scrubbing is essential in medical billing to reduce wait time for owed revenue. Having a claim accepted on its first pass means your company gets paid faster.
Your practice management system will see fewer overdue bills and accounts receivable as a result. Using a tool like a scrubber helps speed up your revenue cycle management (RCM) process!
How Does Claim Scrubber Software Affect Revenue Cycle Management (RCM)?
Scrubbing claims before submission to insurance companies is essential to reduce claim denials. In claim processing, identifying errors early is the name of the game. Clean claims in medical billing boost your claim acceptance rate and streamline your billing process.
Accelerating your payment cycles through timely reimbursement not only strengthens your bottom line but also reduces administrative burden on your team.
The less time your billing experts spend on chasing overdue payments, the more time they can focus on more pressing coding and billing matters. This includes ensuring proper coding and claims submission in the first place!
Key Features of an Effective Claim Scrubber
Having an effective built-in claim scrubbing software helps your company in many different ways. Most of which I already addressed, but for the sake of thoroughness, let's go over them again! As well as some benefits I haven't even touched on yet.
Automation
No need to waste your time on manual claim scrubbing. Automation is a huge selling point when it comes to investing in claims management software. Reduce administrative costs and the need for extra billing staff with automatic claim validation services.
Improve Cash Flow
Submitting accurate and clean claims the first time helps to improve financial efficiency. Prioritizing smooth and streamlined processing of electronic health records (EHR) includes improving your billing accuracy. Avoid billing bottlenecks and strengthen your accounts receivable with claim scrubbing.
Boost Productivity
Reducing the need for manual claim scrubbing, as I mentioned early, frees your team for more urgent matters. Healthcare organizations should not spend the majority of their time chasing late payments. Instead, they need to focus on their patients' needs and care. This, in turn, boosts patient trust and your credibility as a medical facility.
Increase Patient Satisfaction
If patients are less likely to face billing issues and delays if their providers submit clean claims the first time around. Hounding your clientele for their payments is bound to cause a strain on your professional relationship with them. Avoid these scenarios by prioritizing claim accuracy and compliance through proactively scrubbing data.
Compliance
Staying in compliance by adding a layer of data entry accuracy is key. You can ensure your claims meet regulatory requirements and adhere to different payer guidelines this way. In turn, your organization can more effectively avoid penalties in a legal situation. In case of an audit, you have this proof of adherence to reference. Reduce your delays caused by non-compliant submissions, too.
Choosing the Right Claims Scrubbing Solution
When considering different RCM software, there's a lot to consider. Luckily, we are here to help break it down for you. In an easy-to-understand and palatable way! Let's start with the most basic step: understanding your current processes.
Understand Your Current RCM Cycle
Before diving into a system you aren't familiar with, you need to first familiarize yourself with your current software. Look at how your data flows from end to end. This includes processes such as:
Registration.
Verification.
Coding.
Claims.
Payments.
Denials.
Patient billing.
Keep in mind where your current trouble spots are. This can look like long waits on claims, rejections, and high denial rates. Talk to people who work at each point of data conversion. This might include receptionists, definitely your medical coders and billers, and even providers.
Track the number of days in accounts receivable and any patient billing lag. Don't forget to document the systems you currently use. Such as EHR or any payment tools. Performing this sort of self-audit helps you see where there might be gaps in your process. Ask these questions:
Are claim denials costing my company?
Is coding slowing my team down?
Think Integration & Automation
Make sure your current billing tools plug into the new scrubbing software. Your new claim scrubber should connect with your EHR, lab scheduling, patient scheduling, and payers (to name a few). The right integration will reduce the need for data entry.
Claim scrubbing aside, look for auto-checks for eligibility. As well as payment posting and sometimes even tools that auto-suggest correct codes.
Automation means reduced duplication as the connection should allow for payer information and codes to flow through automatically. Connected systems are essential for reduced manual labor and a more streamlined workflow!
Consider Metrics & Features
Let's go over some must-have features when deciding on scrubbing software. Other than automation capabilities, which arguably is the most important.
Look for real-time dashboards. Having clear visibility of what affects your finances is essential. Your dashboard should offer insights on these metrics:
Denial rates.
A/R days.
Claim clean rates.
Patient payments.
Also, having access to reporting and data in the event of an audit is important here. In today’s digital age, you should be able to pull financial and operational data at the drop of a hat. This helps you run compliance reports easily. A perfect segue into my final must-have function: security and compliance.
Working in the medical field, you need to comply with HIPAA. Having electronic protected health information (ePHI) at your disposal means regular software updates. On top of staying current with regulations.
Boosting Cash Flow in Real-Time with Medical Claim Scrubber Software
In an ever-changing industry, rising denial rates are not entirely unexpected. But it doesn’t have to be your company’s norm! Even as payer requirements change, with the right tools, you can rest assured that your team will stay in the know.
The right claim scrubber software gives your billing team the head start needed to catch errors before they cost time and money. And the right vendor will help you navigate through your roll-out with ease. When vetting vendors, look for proven experience working with companies similar to your own. Confirm they offer strong onboarding, including ongoing training and customer support.
Investing in the right clearinghouse and scrubbing software is irreplaceable. It means prioritizing your company’s financial health. Stay ahead of denials, streamline your revenue cycle, and protect PHI with claim scrubbing software.
