Claim Scrubbers Workflow

March 4, 2024
Monica Ayre

As you pour your heart and soul into caring for your patients, the last thing you want is to deal with revenue leaks in your private practice. You strive to deliver exceptional care and look forward to a streamlined claim submission process that saves your valuable time and that of your patients and insurers.

Yet, your efforts often encounter setbacks due to tangled claim submissions, drained resources on rectifying errors, and disrupted revenue cycles, potentially leading to frustration and lost revenue.

So, how do you bypass this hurdle?

Claim scrubbing acts as a meticulous editor, akin to a grammar check for medical billing, addressing all coding and billing errors before the final submission, much like refining a crucial document before publication. It ensures a streamlined, error-free submission process that safeguards revenue and liberates you to channel your energy back into your primary passion — providing exceptional patient care.

Let's dive deeper into the claim scrubbing process, understand why it's imperative in your practice, and the pivotal role that automation plays in it.

What Is Claim Scrubbing? How Is It Done?

Claim scrubbing is the process of identifying and fixing claim errors before sending the bills to the insurance company. It's like having a careful proofreader for medical bills.

Claim scrubbing helps prevent common errors such as deleted CPT code, invalid CPT for patient gender, duplicate DX code, mismatched DX code for patient age, invalid modifier for patient age or gender, and more. Claim scrubbers spot these errors and flag them so coders/billers can rectify them and submit clean claims. The scrubbed claims enter the insurance system accurately as error-free claims.

Another form of scrubbing, known as charge scrubbing, occurs before the compilation of medical billing reports for submission to insurers. Unlike a claim scrubber, which audits reports before submission, a charge scrubber conducts its audit even before medical billers assemble the claim.

How Does Claim Scrubbing Boost Your Practice Revenue?

Claim scrubbing serves as a vital checkpoint in identifying and rectifying errors in claim submissions, contributing to a smoother and more efficient medical billing process. Increased clean claims mean fewer denials, delays, or payment rejections, leading to enhanced overall revenue cycle efficiency and a reduced administrative load for healthcare professionals.

Claim scrubbing offers several benefits, which include:

  • Improved Accuracy — Identifies and fixes errors, inconsistencies, and missing information in medical claims, generating clean claims.
  • Reduced Claim Denials — Mitigates claim denials caused by missed or incorrect codes, facilitating the submission of clean claims and reducing the likelihood of denials.
  • Faster Reimbursements — Ensures faster processing of clean claims by insurance companies, leading to swift reimbursements.
  • Optimum Operational Efficiency — Alleviates the time-consuming resubmission process, communication overhead with insurers, and additional administrative workload associated with denied claims, allowing healthcare professionals to work more efficiently.
  • Enhanced Compliance Identifies and flags deviations from coding standards and regulatory requirements, safeguarding healthcare providers from the risks of audits, penalties, and legal issues.
  • Cost Saving and Revenue Boost — Accurate claim processing minimizes the need for appeals and resubmissions, saving resources and ensuring timely reimbursement, thus boosting revenue.
  • Improved Patient/Payer relationships Timely and accurate billing fosters trust with patients and insurers. Patients appreciate precise and transparent bills, enhancing satisfaction, while insurers value the efficiency of error-free claims, contributing to improved relationships among all stakeholders.

Why Should You Automate Claim Scrubbing?

The healthcare staff shortage, exacerbated by the challenges of the COVID-19 pandemic, is projected to escalate, potentially resulting in a shortfall of up to 124,000 physicians by 2033. Furthermore, according to an MGMA Stat poll, 34% of medical groups highlighted that finding and hiring medical coders is their most significant challenge. This mounting staff crisis has significantly increased burnout rates among healthcare professionals, unfortunately impacting coding and billing accuracy.

Manual claim scrubbing places an additional burden on an already exhausted workforce grappling with staff shortages. Moreover, the intricate and unpredictable nature of claim processing further complicates matters, putting an added strain on the system.

Manual claim scrubbing poses several challenges:

  • Time-Intensive — Manual claim scrubbing is slow, delaying the billing process.
  • Workload Burden — Adds strain to healthcare professionals amid staff shortages.
  • Error-Prone — Human errors are inherent in manual processes.
  • Inconsistency — Varies in approach, hindering standardization.
  • Limited Scalability — Manual processes may struggle to scale efficiently as claim volumes increase.
  • Processing Delays — Susceptible to delays during peak work periods, impacting reimbursement timelines.
  • Resource Drain — Demands skilled workforce, diverting resources.
  • Adaptability Challenges — May struggle to adapt quickly to changing coding standards and regulatory requirements.
  • Higher Costs — Labor-intensive, contributing to elevated administrative costs.

Automated claim scrubbing stands as a superior alternative to manual methods. It significantly expedites the claim processing workflow, ensuring prompt handling of claims and quicker reimbursements. These computer systems employ robust algorithms and rules for rapid and accurate claim analysis. The system's consistency minimizes human errors, enhancing compliance with coding standards and regulations.

It seamlessly adapts to varying claim volumes, ensuring scalability and effectively addressing staff shortages. Furthermore, automation frees human resources from mundane tasks, enabling professionals to concentrate on strategic and patient-centric activities.

Plug Your Practice's Revenue Leaks Today

Claim scrubbing guarantees a seamless and error-free submission process, proactively addressing potential revenue leaks that may occur from claim denials due to errors in submitted claims.

At Glenwood, our focus is to ensure that private practices operate smoothly. We verify every service is billed accurately and no bills are left uncollected. Moreover, GlaceRCM offers various charge capture points, including GlaceEMR, third-party EMRs, mobile devices, and daily rounding software, providing practical solutions for practitioners. Our vast knowledge base allows us to run validations that catch potential coverage and coding errors, preventing denials. You can confidently navigate billing complexities, ensuring they maximize revenue and maintain a financially sustainable operation.

GlaceRCM/EMR - Billing Service For Private Practice

Schedule a Free Consultation!

Check - Elements Webflow Library - BRIX Templates

Thank you

Thanks for reaching out. We will get back to you soon.
Oops! Something went wrong while submitting the form.

Subscribe to our Newsletter

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.