What Are Claim Scrubbers?

What is claim scrubbing?

Claim scrubbing is the process of scanning your practice’s medical claims for errors that would cause payers (i.e., insurance companies) to deny the claim. Claim scrubbers, whether people or computer programs (we’ll explain both in a bit), verify the Current Procedural Terminology (CPT) codes on your claims. This is important because, although representing your services with five-digit numbers is convenient, just one wrong digit can result in a denied claim.

Who offers claim scrubbers?

Claim scrubbers are primarily available through third-party medical billing services and the best medical software on the market. For example, the medical software company athenahealth uses automated rule engines to identify mistakes that would lead to denials. Medical billing company AdvancedMD goes a step further and uses its clearinghouse partner’s preferred scrubbing tool. In both cases, the vendors’ claim-scrubbing technology catches errors far better and faster than humans can.

For the above reasons, when you see the term “claim scrubber,” you can generally assume it refers to automated third-party services. Yes, individuals can scrub claims, but you’ll soon learn that there’s little reason for anyone on your medical staff to do it.

Manual vs. automated claim scrubbers

Claim scrubbing is a process that your front-office staff could theoretically handle manually. After all, they have eyes and brains; they would be able to see CPT codes and verify that these numbers match the services provided. In reality, though, it’s a formidable challenge to understand and recognize each of the thousands of CPT codes. Plus, to ensure HIPAA compliance, CPT codes are constantly changing.

Additionally, even front-office staff members who do know CPT codes might miss incorrect codes. When they’re looking at code after code, they will inevitably start to gloss over the details. This is why you often miss obvious typos when you write, and why your front-office staff might miss incorrect codes. Just as spell-check exists for catching typos, computer tools exist for scrubbing claims.

How does a claim scrubber work?

Claim scrubbers work by checking claims for errors after creation but before filing with payers. Once a claim is created and ready to submit, claim scrubbers scan it for errors before it goes anywhere. If claim scrubbers detect errors (and mistakes are common), a medical biller or coder will manually rectify the claim. Assuming the biller or coder follows the claim scrubber’s exact instructions, claim approval is likely.

You may occasionally encounter something called a “charge scrubber.” This term is roughly the same as “claim scrubber,” though technically, charge scrubbers check for errors before a claim is even created. The result is ultimately the same – accurate claims with quick verification times. It’s just the timing that’s different.

Why is claim scrubbing important?

The importance of claim scrubbing can’t be understated. These are some key reasons why claim scrubbers should be part of every practice’s medical billing process:

1. More accurate claims (and fewer denials)

The obvious benefit of claim scrubbing is that it results in more accurate claims. The more often your claims are accurate, the fewer denials you face. As a result, you’ll encounter fewer obstacles to getting the money you need from payers.

2. Quicker payments

Denied claims hold up the payment process. With no approval on your claims, how can you receive payments? With claim scrubbers, you’re far more likely to submit an accurate claim the first time, enabling payers to pay you on time. The result is more revenue and cash flow that your practice can use to cover its needs.

3. More time back

Manually poring over your claims for errors isn’t just an easy way to make mistakes; it’s also time-consuming. With claim scrubbers, your team spends no time on the process. Instead, a computer program does the work more efficiently and quickly. You’ll catch far more errors in a fraction of the time. This means your front-office staff can use that newly freed time for actual patient interactions.

4. Better payer relationships

In 2019, 92 percent of Americans had health insurance. That means payers, not patients, are the primary source of revenue for healthcare organizations. Submitting incorrect claims time and again to these payers is a surefire way to get on their bad side – especially since many payers have their own unique requirements for claims. Why would a payer keep working with you if you consistently ignore their rules?

Claim scrubbers solve this problem. They lead to a substantial reduction in the number of erroneous claims you file, creating better relationships with your payers. Excellent claim-scrubbing practices can also help you make a case for yourself when connecting with new insurers to broaden your network. Thereafter, more patients are able to choose your practice.

5. Better patient relationships

Frequent claim denials don’t only affect payers. Patients often get annoyed when claims are denied. Think about it: After going to your doctor, wouldn’t you be irked if you got a bill for services you expected to be covered? A practice with patients who regularly experience this problem might not keep those patients for much longer.

Claim scrubbers again nip this issue in the bud. As they lower your claim denial rates, your patients are more likely to receive the coverage they expect for your services. When you meet the patient’s expectations, they’re far more likely to come back. Between patient retention and your expedited claims process, your practice is looking at more revenue more quickly.

Best medical software with claim scrubbers

If you’re in the market for medical software that offers claim scrubbers, these solutions have what you need. Check out their full reviews below to learn more about each platform and whether it’s right for your practice.

• AdvancedMD: AdvancedMD offers one of the most robust and powerful medical software platforms on the market that’s still suitable for small to mid-sized practices. It includes an effective claim scrubber aligned with the company’s preferred clearinghouse; this helps to catch nearly all errors on the first pass. Read our AdvancedMD review to learn more.
• athenahealth: The biggest benefit of working with athenahealth is access to the athenaNet network of other medical providers. The system’s claim scrubber learns from mistakes made across the entire network and consistently updates its rules engine to account for these errors. Read our athenahealth review to learn more.
• DrChrono: DrChrono is a good choice for small practices that want the advanced functionality of a medical software with built-in claim scrubbing. Cost-effective and user-friendly, this platform doesn’t disappoint and won’t break the bank. Read our DrChrono review to learn more.
• CareCloud: CareCloud is an easy-to-use medical software tool that incorporates a wide range of useful features for both medical practices and patients. Its claim scrubbing tool is effective and regularly updated as new errors or payer trends are discovered. Read our CareCloud review to learn more.

How to get started with claim scrubbers

Ready to use a claim scrubber in your practice’s billing operations? We’re here to help you find the right one. Check out our picks for the best medical billing services, many of which offer claim scrubbing. When you look at our best picks, you’ll see which vendor might be best for you based on your medical practice’s size, specialty, needs and other factors. Once you implement your medical billing system, consistently accurate claims – and the money that follows them – are nearly guaranteed.