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.
Clean claim submission can reduce average days in AR to less than 45 days
The leading medical billing services utilize scrubbers that ensure your claims are clean before they are submitted to payers. These scrubs accelerate the speed of collections by avoiding denials and delays. They also increase collections by minimizing the volume of "re-work" and allowing billing staff to focus their efforts on pursuing true collections improvement opportunities and not simply resubmitting claims that should have been paid the first time. As a result of these scrubbers, over 90% of claims submitted are paid upon first submission. These "scrubbers" include:
- A minimum requirements 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 two scrubbers are the bare minimum that any medical billing company needs to employ. The next level of scrubber is one that captures in a systematic and easily utilized manner the knowledge base that the medical billing service has developed over years of serving multiple clients, specialties and states. In order to do this, the medical billing company needs a scrubber that allows them to create their own rules:
- Dynamic Proprietary Rule scrubber that checks for optimal coding and documentation versus each particular payer or plan's rules. This scrub assures that each claim is optimized for clean submission. When the payer or plan's rules change or when the billing office detects a systemic issue they should update the scrubber to filter and fix problems before claims are submitted. These specialized scrubbers differentiate the Tier one medical billing companies from the rest of the crowd and can make a significant collections difference.
Consistent use of the scrubbers outlined above can decrease a medical practice's collections cycle by up to 50 days. This is why you need to insure this critical step is being completed no matter who is doing your Medical Billing.
Copyright 2008 Carl Mays II - 15431
Clean claim submission can reduce average days in AR to less than 45 days
The leading medical billing services utilize scrubbers that ensure your claims are clean before they are submitted to payers. These scrubs accelerate the speed of collections by avoiding denials and delays. They also increase collections by minimizing the volume of "re-work" and allowing billing staff to focus their efforts on pursuing true collections improvement opportunities and not simply resubmitting claims that should have been paid the first time. As a result of these scrubbers, over 90% of claims submitted are paid upon first submission. These "scrubbers" include:
- A minimum requirements 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 two scrubbers are the bare minimum that any medical billing company needs to employ. The next level of scrubber is one that captures in a systematic and easily utilized manner the knowledge base that the medical billing service has developed over years of serving multiple clients, specialties and states. In order to do this, the medical billing company needs a scrubber that allows them to create their own rules:
- Dynamic Proprietary Rule scrubber that checks for optimal coding and documentation versus each particular payer or plan's rules. This scrub assures that each claim is optimized for clean submission. When the payer or plan's rules change or when the billing office detects a systemic issue they should update the scrubber to filter and fix problems before claims are submitted. These specialized scrubbers differentiate the Tier one medical billing companies from the rest of the crowd and can make a significant collections difference.
Consistent use of the scrubbers outlined above can decrease a medical practice's collections cycle by up to 50 days. This is why you need to insure this critical step is being completed no matter who is doing your Medical Billing.
Copyright 2008 Carl Mays II - 15431
About the Author:
Carl Mays II, CEO of ClaimCare Medical Billing Services, has spent the past 15 years improving the operations of his clients. To read more about what to look for in Healthcare Billing Services subscribe to Carl's blog
