The best way to reduce outstanding receivables in a medical provider’s office is to make sure that claims being sent out are clean. Clean claims require less effort in collecting payment and result in faster payments. Claims with errors come back as denials and then need to be corrected, resulting in a delay in payment for services, and possibly no payment at all. After all, 42% of denied claims are never appealed or corrected.
Most provider offices do not have the time or the manpower to take care of denials in a timely fashion and it is one of the largest sources of lost money in a medical office. Sending out clean claims results in over 90% being paid on the first submission, leaving less than 10% of claims to be denied. By eliminating the avoidable errors, the real issues can be addressed and less money will be lost. One good way to ensure clean claims is by having a good claim scrubber in place. Many billers do not even know what a claims scrubber is but it actually influences your receivables in a huge way.
A claim scrubber analyzes the data that is on the claim and compares the data to its rules engine before the claim is submitted. There are several levels of claim scrubbing and good claim scrubbers will analyze data on many levels. The most basic claim scrubbing function is to make sure that all required data is present. For example, it will check to make sure a name, valid date of birth, insurance information and id number are present. It will also verify that there is a date of service and a procedure and diagnosis code. But it may not verify if the data is accurate. For example, a basic claim scrubber may not notice if a date of service entered was mistyped and is for an obviously incorrect date, such as 04/01/2001. To a biller it is obvious that the entry person made a typo, but a basic claim scrubber may not catch this.
Another example is if an invalid insurance identification number is entered. Medicare identification numbers are a social security number followed by a letter, sometimes also followed by another number. If the person entering the claims makes a mistake and misses one number, a basic claim scrubber may not notice. But a good claim scrubber would pick up that there were only eight digits instead of nine, giving the user a warning that the claim may have an error.
Today claim scrubbers come with many more capabilities. They not only verify required data is present, but they also analyze icd-9 and cpt codes. They use rules from CMS and other major insurance carriers to detect mismatches and invalid combinations. Warnings will be given if data does not appear to meet carrier guidelines.
Now with web based software the claim scrubbers have improved even more. With the use of data mining a claim scrubber can build on its own knowledge base by continually reevaluating the adjudication rules of different payers. The claim scrubber is constantly improving its own quality of scrubbing capabilities. With this type of scrubbing capability a provider can reduce the percentage of human error and greatly improve the number of clean claims submitted.
Most practice management software systems with electronic claims capabilities come with some form of a claim scrubber. It is important to know how complete the claim scrubber that you are utilizing is. A good claim scrubber can have a huge effect on the accounts receivable of an office.
When we switched from a server based practice management system to a web based system we found that the claims scrubber on the web based Xena Health system caught up to 50% more errors that would have caused denials. The claims scrubber on our old system would have allowed those errors through creating much more work on the back end.
Some of the features in a product like the Xena Health’s inbuilt claims scrubber include
• Required field checks
• Required format checks
• ICD-9 checks and specificity
• E & V code checks
• CPT validity
• HCPCS validity
• The CMS Correct Coding initiative
• Local and national coverage determinations where appropriate
• Payer specific requirements