One of the most important things in billing is to create and follow a very structured plan that can be measured each step of the way. Remember, if it cannot be measured and monitored it cannot be improved! One key element of this plan must be how to consistently and reliable create clean claims.
Clean claim submission can reduce average days in AR to less than 45 days
One of the best tools for insuring claims are clean before they are submitted is a claim scrubber. A claim scrubber takes the rules that payers use to adjudicate claims and applies them to the claims befroe they are ever submitted. This eliminates avoidable denials and thus speeds up collections. In addition, it frees up time in the billing process for staff to focus on activities that help increase collections instead of just correcting avoidable problems. Every Medical Billing Company should utilize at least the following scrubbers:
- 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.
- Scrubber that checks coding, bundling, and procedure information versus local Medicare and CCI rules. This scrub assures better coding, identifies overlooked procedures or codes.
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