Claim Scrubbing: What It Is and How It Affects Medical Billing

by  Find-A-Code™
Aug 1st, 2023

A medical biller's number one priority is guaranteeing that every claim is accepted and paid the first time. However, things do not always work out that way. Claims can be rejected due to errors, lack of information, or even not being submitted in a timely manner. One way to avoid rejected claims is to employ claim scrubbing.

How important is claim scrubbing? The State of Claims – 2022 report from Experian Health reveals that 75% of the claims professionals surveyed say that their claims are rejected between 5% and 15% of the time. That is a lot of rejected claims. Every rejected claim represents more time and effort put into the payment process. Ultimately, rejected claims reduce profitability.

Claim scrubbing can minimize rejected claims by catching errors before claims are submitted. It can be deployed with software, human workers, or a combination of both. Implemented correctly, claim scrubbing can save healthcare providers both time and money.

Why Claim Scrubbing Is Necessary

At first glance, it might seem that claim scrubbing should not be necessary. After all, medical coders and billers can check their own work for mistakes, right? Not so fast. Reality paints another picture. Between ICD-10 and CPT codes – the two most common code sets in medical billing – coders and billers have tens of thousands of codes to work with. The level of detail they must account for is astonishing. So much so that it is easy to get lost in those details.

The other thing to consider is that it's difficult for coders and billers to spot errors as easily as it is for third parties. Compare it to writers and editors. Writers are familiar with their own work, especially having spent hours on it. They have a less detailed eye when it comes to going back and finding mistakes. That's why they send their work to editors. It is fresh to the editor's eyes, so finding mistakes is easier.

How Claim Scrubbing Works

Claim scrubbing is by no means complicated. It involves examining each line of a claim to verify the accuracy of its billing codes. Where mistakes are found, they are either corrected by the scrubber or the claim is sent back to a coding or billing specialist.

There are two options for implementation:

• Automated Scrubbing – Automated scrubbing utilizes a software package to scan data and spot errors. The most advanced among them utilize artificial intelligence (AI) to compare large data sets for greater accuracy.
• Human Scrubbing – Human scrubbing is just as the name implies. It involves coding and billing specialists who review every claim manually. They check claims against clinical notes in search of any errors.

An ideal situation would combine automated and human scrubbing for the most accurate results. An automated software package would do the initial work in mere seconds. Afterward, a coding or billing specialist would review the claim a second time. The specialist's role is to confirm the results returned by the automated process.

Timely and Accurate Reimbursements

Medical coding and billing are all about generating timely and accurate reimbursements for healthcare providers. It would be nice if the system were not so complicated, but it is what it is. Therefore, it is incumbent upon billers to do whatever they can to minimize errors and claim rejections. Claim scrubbing is designed to do just that.

Effective claim scrubbing eliminates most errors. It allows for timely billing, reduces rejected claims, and ensures that healthcare providers are getting paid what they are owed. Based on the number of claims payers reject every year, a well implemented scrubbing solution could pay for itself in short order.