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Importance of Medical Claim Scrubbing: Eliminate Errors in Medical Coding and Billing

Importance of Medical Claim Scrubbing: Eliminate Errors in Medical Coding and Billing

Introduction

According to the new USA law, medical practice will only get payment for the services rendered to patients once or if they submit error free medical claims. Medical claims and billing practices with errors could lead to claim denials and rejections. It will contribute to the delayed reimbursement of the services rendered to the patient. Healthcare organizations have to face severe accusations and compel them to waste their resource and precious time to claim and billing settlement process. It also diverges their focus from their medical duty of serving the patients. Loss of trust of patients trust and insurance challenges also could turn out in the form of a total collapse of the business. The article will discuss the importance of medical claim scrubbing and the smooth processing of medical claims.

Error free claim coding

Claim scrubbing has a vital role in certifying the correctness and integrity of medical claims. It appraises the lawsuit against the coding guidelines and rules, uses updated codes, and provides the comprehensiveness and precision of patient information. The error-free handling of medical claims helps to reduce the chances of claim rejection and possible denials. It also contributes to fast and timely reimbursement and guaranteeing the financial firmness of the healthcare organization.

Quicker payments

Manual claim scrubbing is a hard and multifaceted process. In the recent dynamic and advanced healthcare industry, alphanumeric scrubbing has added to increasing the pace of the scrubbing process. Digital claim scrubber assesses the claim, and its convenience and integration feature ensure its fast processing of claims to the insurance companies. It confirms coding accuracy and increases the chances of quicker reimbursement for the services rendered to patients. Trained in-house or third-party team of claim scrubbing help in the faster processing of claims and also more immediate payments.

Accurate reimbursement

Claim scrubbing also contributes to the accurate reimbursement process. Due to up-coding, medical claims get paid higher than expected and sometimes get paid lower than the actual amount. It might be due to medical coding and billing errors in the medical claim. Scrubbing helps remove these errors by ensuring accurate coding for the patients’ procedures, diagnosis, and treatment. Then they can get the appropriate reimbursement amount for the services offered to patients.

Reduce denied claims and faster payments

Insurance companies evaluate medical claims against the guidelines and rules of regulatory compliance. Any claim that is against the policy and has errors has maximum chances of denial. Then appealing and re-appealing add unnecessary hassle in the claim processing process. In the hectic process of claim submission and to avoid the risk of being denied, scrubbing ensure that the claim is free from all medical and billing errors before making its final submission. You can get payment within four days in the best-case scenario. Scrubbing ensures faster compliance of the claim even same day of service rendered to a patient and, in return, gets back more rapid claim approval and payments from the insurance company without any delay.

Regulatory Compliance

Medical coding and billing adhere to regulatory guidelines. These guidelines are issued by the regulatory authority CMS and HIPAA. These authorities changed codes, added new codes, and even deleted some codes annually. Medical coding and billing must follow these guidelines; otherwise, the claim will be denied or rejected. To combat the issue, scrubbing is no less than a blessing. Scrubbing also ensures that the coding and billing follow the guidelines and rules of regulatory authorities. So, that minimizes the risk of claim denial and gains immediate reimbursement against their services.

Enhance patient satisfaction

Billing accuracy depends upon coding compliance. When the coding is accurate, there will be no shield to ensure the transparency of medical billing. The insurance companies or third-party payer issue payment, and the relationships between the insurance companies, patients, and healthcare providers get firmed. Patients get justification for payment due to the transparency of medical bills. It reduces their frustration against the medical staff on payment and increases healthcare providers’ financial stability.

Efficiency and productivity

Medical claim denials due to billing errors are an exhausting and time-consuming activity. Dealing with the denied claim requires resources, time, and stamina. Frequent medical claim denials put a question mark on the transparency of medical practice. Scrubbing reduces billing errors and ensures all medical claims are aligned accurately with the regulatory guidelines. When claims get smooth payment, the overhead of looking after the claim will be reduced. The healthcare provider gets more time to focus on the patient, which contributes to improving their productivity.

Healthcare provider’s reputation

Scrubbing helps in ensuring the accuracy of medical data. It is maintaining reliable, complete, and accurate patient data. When data is accurate and error-free, the chances of claim denials will be minimal. Trustworthy billing simplifies the billing process and constructs confidence between the doctor and patient.

Conclusion

In short, scrubbing is important for ensuring the completeness and accuracy of medical data and the smooth processing of medical billing and coding practices. Scrubbing enhances healthcare providers’ productivity, improves the goodwill of the healthcare organization, builds doctor-patient trust, streamlines claim processing, and eventually contributes to the financial health of healthcare providers and organizations.

FAQs

What is the aim of medical claim scrubbing?

Medical claim scrubbing aims to evade billing and coding errors before submitting the final claim to the insurance company. It aims to scrutinize medical allegations and ensure the claim is error-free. So, that provides to avoid the risk of medical claim rejections or denials. It is done by detecting and eliminating billing and coding errors and checking the accuracy and completeness of information in medical. A third party or healthcare provider is the entity that performs the medical claim scrubbing.

What types of medical coding codes analyze with the help of a claim scrubber?

Claim scrubber is the most common and widely used software that has extensive use in medical billing and claim scrubbing. The software analyzes and processes the ICD, HCPCS, and CPT codes that are part of medical claims. Medical codes are full of complexities and always prone to errors. A scrubber is an automated software that reduces these errors and is also available round the clock with more accuracy than manual coding.

Why is there a need to review the medical claim before its final submission?

Before making a final submission, the medical claims should be reviewed to remove errors and to get prompt payments without hiccups. It is essential to check to protect the suit from denials and save money spent on appeal if the claim fails to review for the first time. The review helps to reduce the risk of claim denials because about one-quarter of denied claims can never be recovered. As a result, medical providers’ services go unpaid, and they incur severe financial loss against their medical practices. That is why claim scrubbing has gained significant importance in the medical sector.

What will be the consequences of an inaccurate claim?

Inaccurate claims could be the primary cause of denials, late reimbursement, and rejection. False claims could result in overpayments, underpayment, or even claim rejection. It reduced billing transparency and integrity of data and broke the confidence connection exists between doctors, patients, and insurance companies.

What is the role of claim scrubbing in catching fraudulent practices?

Claim scrubbing plays a vital role in catching fraudulent practices. It helps ensure transparency and compliance with regulatory guidelines and detects anomalies and inaccurate billing that lead to fraudulent practices.


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