Insurance Claim Scrubbing

Medical Scrubing? Medical Coding? Medical Transcription? Medical Billing? |Everything You Must Know

Medical Scrubbing, Coding and Medical Transcription are all the key processes that help the Health care service provider to maintain the revenue cycle.

The billing process took several weeks to months to complete. It usually initiates when the doctor sees the patient, after the treatment all the record has been converted into the form of codes which later send to the insurance companies to get a claim.

As it is a very long process, In this article, we will break down the details of all these steps which will help you to better understand the medical billing process.

Medical Scrubbing

Medical scrubbing also refers to medical claim scrubbing, in which finding and getting rid of the errors which are found in the claims submitted to the insurance companies.

The errors are most usually found in the coding. In other words, it is the procedure in which the claim is audited before being submitted to the insurance companies.

Reasons Behind Medical Scrubbing

The process of medical billing is very complex; it contains several steps from identification to organizing and utilizing the data. In this process, the first step is to collect the personal details of the patient, the procedure, tests, and treatment he availed during his stay in the hospital.

This process also includes the information about the insurance company which contains the complete detail about the services he can avail of under the agreement and what services are excluded from the agreement.

The insurance companies use some defined sets of code to issue the claim,

For a successful claim, there is a need for proper coding as the process of coding is very complex and the chances of error are also very high.

While there are chances of error the medical claim scribing can reduce the quantity of rejected claims. Which turns into a better cash flow with more successful reimbursement.

Medical Coding

Medical coding is the type of procedure in which all the services and treatment delivered to the patient is stored in the form of codes. These codes are then transferred to the insurance companies by the service providers for a claim.

All this coding procedure is handled by a medical coder whose responsibility is to ensure the accuracy of the bill which is submitted to the insurance company.

Reasons for coding

In medical practice, coding is usually described as the term in which the medical service provider recorded the history of the treatment and services provided to the patient and used it to claim reimbursement from the insurance companies.

This is one view of the broader picture, On the other hand, every day a huge amount of patient data is generated. A medical practitioner Recorded the history of the patient in terms of diagnosis of the disease, possible treatment, and medication. All these records help medical institutions and the government track the effectiveness of the treatment.

Medical Transcription

Transcription is the manual act in which the translator listens to the voice recording and converts them into written form. It includes a person’s medical history like medical treatment diagnosis and other procedures, it is considered as the patient’s permanent medical health record.

Role of Medical Transcriptionist

There are several tasks assigned to a medical transcriptionist. One of the tasks is to accurately transcribe the information related to the patient’s identification like his name, address, the social security number on medical records.

It is also the responsibility of a medical transcriptionist to check the inconsistencies and accurately use punctuation, grammar, and spelling.

The other responsibilities associated with a medical transcriptionist are to report and collect data and maintain a backup up, collect formulate and generate reports based on statistical evidence.

Importance of Medical Transcriptionists

The medical record generated by the medical transcription is helpful for the physician to evaluate the condition of the patient and use it as a reference to treat coming patients.

This medical record is also used by the support staff and nurses to cure the patient effectively according to the doctor’s prescription.

In some cases, the patient switches the doctor, the records which are generated by the transcriptionist will help the new doctor to better understand the condition of the patient with the help of all the previous records, treatment, and medication given to him. So, he can prescribe the best suitable treatment to him.

On the other side, the transcriptionist also helped the coding team by giving them accurate information about the patient’s history and the treatment he availed during his stay in the hospital so they can use this information to bill the insurance company.

Medical Billing

It is a process in which health service providers submit the claim to the insurance company on behalf of the patient who has been treated in the hospital.

Process of Medical Billing

The process of medical billing is described below:

Patient Registration

The first step in the medical billing process is to record the initial data of the patient including his name, age, home address, and insurance provider. This data is very essential which is used during the building process.

In the next step, the service provider will monitor all the details related to patient insurance.

By analyzing those details the service provider will determine the possible treatment process which is covered in the agreement.

Diagnosis

After collecting all the essential details, the patient will consult with the doctor about his health, and then the doctor will evaluate the condition of the patient and prescribe him the appropriate treatment and medications.

Transcription

The meeting between the patient and the doctor is being recorded to make a record of the patient’s medical history. This has been done by the medical transcriptionist, who will listen and document the medical history of the patient which is not only used by other medical practitioners but also used to generate codes for the billing process.

Coding

In the next step, the patient record has been converted in the form of codes. These codes are generated under the guidelines of the American medical association.

The coders usually used CPT and HCPCS codes, which are then forwarded to the insurance companies to submit a claim.

Claim Submission & Payment collection:

After the coding process, the claim has been transferred to the insurance company, which will process the claim if it is submitted within a specific time limit.

Once all these processes are done then the insurance company will transfer the fund to the service provider.

Need Support?

If you need assistance in your medical billing process, contact us at (888) 598-9181.

Med-Miles provides complete medical billing solutions to its clients, from charge entry to payment posting to clean claim submission. We assure you faster reimbursement for an active course of your revenue cycle.

How Does The Process of Claim Scrubbing Help a Medical Practice?

We have seen many changes in medical billing for the past few decades. Many healthcare providers have to follow the rules, regulations, and guidelines required by various insurance companies while submitting claims.

Also, they have to make sure if their claims comply with HIPAA or not?. All these requirements are essential to get reimbursements on time.

But many healthcare practitioners and organizations face denials and late reimbursements due to errors in the medical billing and coding. Errors in billing and coding lead to losses of approximately $128 Billion in the US every year.

Claim scrubbing is the process that helps to lower the risk of errors in claim submissions. It allows you to look for any billing and coding errors, and correct them. It can be done manually or automated.

Stick with us to find out what the claim scrubbing process is and how it can help you with accurate claim submission to avoid errors.

What is Claim Scrubbing?

Claim scrubbing is a process that is performed before the submission of claims to healthcare insurance companies. A medical claim has information about the patient, healthcare provider, individual physician, medical staff, and insurer details. It also includes data about the diagnoses, tests, treatments, and procedures performed for a patient.

You have to double-check all the information entered in the claims before submitting the claim. Otherwise, you will experience denied claims and late payments that can affect your revenue cycle.

Claim Scrubbing Can Improve Your Medical Practice

Errors in medical billing are common because the thousands of coding requirements by third-party healthcare insurance create room for coding errors. A single mistake in a submitted claim can lead to denial, and you would not get payments for your medical practice on time.

Your claim has to be 100% error-free for accurate submission of claims. And, even if you submit 100% clean claims, you still might face denied claims. Claim scrubbing helps you avoid further errors for the accurate submission of claims.

The revenue cycle of a medical practice depends on the accurate submission of claims, and clean claim scrubbing can help you achieve more profitability.

It requires thorough research of claims and allows you to make your claims in compliance with all the rules and requirements. Your medical practice can be at risk if you face many denied claims and late or low reimbursements. Hence, you must implement claim scrubbing in your medical billing process.

How Can You Optimize the Claim Scrubbing?

As discussed earlier, claim scrubbing can be manual or automated; it depends on how you want to do it and your budget. If done correctly, it can improve the revenue cycle of your medical practice. The following methods can help you optimize your claim scrubbing process:

Use Claim Editing Software

It is best to use claim editing tools to check if there are any errors in medical codes. Verify if you are using the right codes issued by coding regulatory authorities. ICD-10 includes almost 70,000+ procedure codes and 69,000+ diagnosis codes. And, there are numerous HCPCS and CPT codes as well.

Human errors are the prominent cause of claim denials, so it is sensible to use claim editing tools to avoid claim issues. Automating the claim scrubbing can save you a lot of time and money.

Rectify the Repeated Errors

Sometimes, you might face the same coding errors over and over again. In that case, you need to look for repeated code errors. You can discuss the issues related to coding with the medical staff, administration, physicians, or coders to identify the root causes and rectify them to avoid errors in the future.

Perform a Charge Review

The charge review process is performed before the creation of a claim. It is for finding out any inaccuracies in charges when you are going to bill a patient. Sometimes a claim may be rejected due to errors in the payments charged by a healthcare provider, leading to coding errors.

Various charge review tools can help you automate the process of charge review. The software will check for the mistakes in charged amounts before submitting them in a claim.

Outsourcing Your Claim Submissions

You still might be facing denied claims even after following proper practices of claim scrubbing. It means your office might lack the experience or not be aware of the successful claim practices for dealing with the claims.

Also, If you feel you do not have enough time and budget to manage claims by yourself, you can get a claim handling service from a medical billing company like Med-Miles LLC.

We provide the best medical billing services nationwide and can handle all your claims. We can help you avoid denied claims and late reimbursements with our customized claim processing services.

This way, you won’t have to worry about claim scrubbing by yourself as we will take care of the whole process for you.

When you outsource your claim handling, you can save time for your practice and care for patients. Rely on Med-Miles LLC for all your medical billing needs. Contact us today to get error-free claims and save your time and money for your practice.

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