Claim denials are costly to correct and resubmit. They impede revenue flow, slow down patient care delivery, contribute to poor patient experience and satisfaction, increase administrative workload and take up limited staff time and resources. While they’re avoidable, trends show claim denials are on the rise, costing health systems billions of dollars. According to Experian Health’s State of Claims 2022 report, 30% of respondents encounter medical claim denials in 10-15% of cases, with 42% reporting an increase in denial rates from year to year.
Moreover, rebilling payers often proves fruitless. Despite taking up resources and staff time and productivity and slowing down healthcare delivery, reworked and resubmitted claims denials often face repeated rejection. A KFF brief on claims denial noted that even though it’s uncommon for consumers to resubmit denied claims, insurers usually stick to their original decision when resubmissions occur.
Unsurprisingly, preventing claims denial and streamlining the claims management process has become a pressing need for revenue cycle leaders. The report also revealed that 70% of respondents consider claims management and reducing denials as top priorities. However, the reality of a drop in claim denial rates becomes tangible only when healthcare organizations start to automate claims processes. Claim Scrubber sets the standard as a software solution that effectively reduces denial rates, by ensuring that providers submit clean claims from the start.
What is Claim Scrubber?
Claim Scrubber is an automated software solution that helps healthcare providers identify errors that may lead to incorrect billing and claims denials and submit clean, thorough and accurate claims every time. It reduces undercharges and denials, ensures timely billing and payments, improves staff time and productivity and increases cash flow and bottom lines.
This tool is built to seamlessly complement Experian Health’s other claims processing solutions, including ClaimSource® and Denial Workflow Manager. By adopting these solutions, healthcare organizations can enjoy the full range of benefits in their claims processing and management experience while benefiting from timely, uninterrupted cash flow and higher revenue.
How does Claim Scrubber work?
Claim Scrubber is designed to consistently and reliably help healthcare staff produce clean and accurate claims that are more likely to be approved by payers. Here’s how:
- Claim Scrubber meticulously analyzes each line of every pre-claim to ensure accurate coding and information before submission to the claims clearinghouse.
- After completing the analysis, Claim Scrubber provides general and payer-relevant edits that pinpoint incorrect code combinations or other issues that could lead to claim denial.
- These edits are stored within the Claim Scrubber portal and can be conveniently accessed by users from their PMS and HIS.
- Claim Scrubber details reasons for flagging a claim so users can make appropriate corrections before submission.
- Claim Scrubber enables users to make edits in alignment with payer policies by using Experian Health’s comprehensive database of commercial payer policies and content.
- Claim Scrubber also identifies when the billed amount is less than the payer-allowed amount, helping health systems catch and correct undercharges.
- Claim Scrubber cleans claims, making them error-free by working with the latest and most up-to-date data.
- Claim Scrubber is fully functional in batch mode.
- Claim Scrubber operates on a secure VPN connectivity feature to ensure secure and rapid responses for real-time integrations.
How can Claim Scrubber help improve claims management?
Claim Scrubber optimizes claims processing by providing revenue cycle decision-makers and their teams with solutions that identify potential coding and billing errors upfront, ensure error-free claims submission to payers or clearinghouses, prevent undercharges and underpayment, increase first-time pass rates and prevent costly, time-consuming rework and rebilling that may result in a second rejection.
Additionally, Claim Scrubber enables healthcare organizations to comply with and meet price transparency rules by staying updated on coding variances. Users can also revise flagged claims, ensuring appropriate and accurate corrections are made with access to Experian Health’s extensive commercial payer policies and content database.
Claim scrubbing occurs within 2.7–3.0 seconds, ensuring speedy transaction processing that leads to faster reimbursements. Healthcare organizations can also enjoy these benefits without the hassle of needing servers, regular maintenance and downtime with Experian Health’s cloud-based application.
See how State of Franklin Healthcare Associates used Claim Scrubber to expedite accounts receivable (A/R) by 13% and reduced full-time employee (FTE) requirements even as claims volume grew.
Healthcare organizations that automate claims management gain advantages that benefit all stakeholders and bottom lines. Claim Scrubber enhances operational efficiency, staff productivity, resource utilization, patient experience and satisfaction and hospital cash flow and financial growth.
Contact us today to learn how Experian Health’s Claim Scrubber software can help your healthcare organization submit clean, thorough claims and get paid faster and more accurately.
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