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Business Outsourcing If You Are Not Scrubbing Your Claims You Are Losing Money
Business Outsourcing If You Are Not Scrubbing Your Claims You Are Losing Money
| If You Are Not Scrubbing Your Claims You Are Losing Money |
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| Written by Carl Mays II |
| Thursday, 23 October 2008 09:21 |
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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. Implementing a process that submits clean claims can lead to days in AR of less than 45. 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). - Core coding scrubber that compares the claim's coding to local Medicare and Correct Coding Initiative rules. Such a scrubber should not only identify negative issues (e.g., a diagnosis/procedure mismatch) but also improvement opportunities (e.g., this procedure is typically performed in conjunction with a second, billable procedure, that is missing from this claim). 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. 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 About the Author: Carl Mays II, CEO of ClaimCare Medical Billing Services, has spent the past 15 years enhancing the financial performance of his clients. To read more about selecting Healthcare Billing Services subscribe to Carl's blog Kindly provided by MoneyHunter.org You are welcome to use this article on your own website, if you include the link just before this text. |
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