02 Jan Scrubbers: What Role Do They Play in Healthcare Revenue Cycle Management?
Scrubbers Clean Your Claims for Potential Errors — So You Get Paid
In the world of healthcare revenue cycle management (RCM), what is a “scrubber,” and what does it do?
It’s a software program that’s designed to identify and correct errors in medical claims before they’re submitted to insurance companies. It ensures that claims are accurately submitted and payments are collected efficiently. Scrubbers improve the overall financial health of medical practices like yours by improving the accuracy and speed of medical billing.
Revenue cycle management is the process that works to ensure that healthcare providers like you are compensated correctly and in a timely manner for the services you deliver. But because of the complexities of medical billing, insurance requirements, and coding standards, errors can often occur. These errors can lead to claim denials, delayed payments, or even fraudulent charges, all of which can significantly weaken your medical practice’s financial stability.
What is a Scrubber?
A scrubber is an automated system or software tool that scans the claims for coding errors, missing information, or discrepancies that could cause the claim to be rejected or delayed. It essentially “scrubs” the claim clean by flagging potential issues and suggesting corrections.
A scrubber verifies that a claim’s medical codes and patient data are accurate, complete, and compliant with payer-specific requirements, which may include specific billing codes (such as ICD-10 for diagnoses, CPT for procedures, and HCPCS for supplies) and payer-specific guidelines that can vary depending on the insurance provider.
How Does a Scrubber Work?
A scrubber utilizes advanced algorithms and rule-based engines to analyze claims for red flags, and it follows these steps:
- A scrubber validates data by checking that the claim includes necessary patient and provider information and the data is correctly formatted. It certifies that personal identifiers, such as name, address, and date of birth, match the payer’s records. A scrubber also verifies that the provider’s National Provider Identifier (NPI) is accurate.
- A scrubber confirms code accuracy by ensuring that the medical codes (such as diagnosis codes, procedure codes, and supply codes) are correct and properly linked. It checks that the codes match the patient’s diagnosis and treatment and comply with the payer’s guidelines.
- A scrubber verifies compliance with regulatory standards, such as those set by the Centers for Medicare & Medicaid Services (CMS) and the Health Insurance Portability and Accountability Act (HIPAA). A scrubber identifies any discrepancies or missing information that could lead to compliance issues.
- A scrubber guarantees adherence to payer-specific rules. Because different insurance providers have their own billing requirements, a scrubber cross-references the claim with the payer’s guidelines by checking for authorization codes, modifiers, or restrictions on certain procedures.
- A scrubber detects and flags errors by identifying potential issues such as a missing modifier, a mismatch between the diagnosis and procedure codes, or more complex issues, like incorrect insurance plan details or billing for non-covered services.
- A scrubber also suggests corrections once it identifies an error. For example, if a diagnosis code doesn’t align with the procedure code, the scrubber may suggest a more appropriate code.
What Are the Benefits of Using Scrubbers?
- Reduction in Claim Denials: By identifying and addressing errors before claims are submitted, scrubbers significantly reduce the chance a claim will be denied, resulting in fewer resubmissions, less time spent on follow-ups, and faster reimbursement for services rendered.
- Improved Cash Flow: Since scrubbers see to it that claims are accurate from the start, they lead to quicker payments from insurance companies and patients, which helps maintain healthy cash flow for your medical practice and reduces your financial strain.
- Increased Coding Accuracy: Scrubbers ascertain that the correct codes are used for diagnoses, procedures, and treatments. This quality control not only helps prevent denials, but it also ensures that providers are reimbursed appropriately for the services they provide.
- Enhanced Compliance: Scrubbers keep up to date with constantly changing coding standards, payer requirements, and regulations. By ensuring compliance with CMS, HIPAA, and other regulations, scrubbers help protect providers like you from legal and financial penalties.
- Cost Savings: As a result of preventing errors and minimizing the need for claim corrections and resubmissions, scrubbers can create significant cost savings, since fewer denials mean less time spent on administrative tasks.
- Data Analytics and Reporting: Many scrubbers feature built-in analytics and reporting capabilities so they can provide insights into the types of errors that occur most frequently, which codes are often used incorrectly, and where bottlenecks in the revenue cycle exist. This information can be valuable for
Submit Clean Claims with Medusind
By automating the error-checking process, scrubbers help reduce claim denials, improve cash flow, and ensure compliance with regulatory standards. But not all medical practices like yours have access to sophisticated scrubbers.
There’s a reason why Medusind is considered a national leader in medical billing and collections: we’re experts at deploying scrubbers. And because we submit clean claims, our clients collect up to 25% more claims revenue, up to 40% faster—all while lowering their medical billing costs up to 50%.
Contact us and let’s discuss how Medusind can mobilize scrubbers, along with the rest of our revenue-generating solutions, so that your practice can benefit from accurate and timely reimbursement in a healthcare world where billing and reimbursement are becoming increasingly complex.
