Medical billing is a complicated process. It involves information going from the patient, the doctor, and the insurance company covering costs. Data scrubbing is used primarily to ensure the format of the bill is understood by the insurance company.
Once the services have been given by a licensed doctor, codes are used to show what those services were, from the initial visit to specialized care. For diagnoses, ICD codes are added to the bill. CPT codes are used for the treatments of the diagnosis. When the codes are not aligned with those of the insurance company, a claim may be denied.
Certain technical protocols and standards used by the industry must be met for an insurance claim to be accepted between the doctor’s office and the insurance company. Billing specialists generally use software to record the data of the patient, the care that was given, and the doctor’s information.
However, there is no universal software application used across the board by healthcare providers and insurance companies. There are, however, insurance claims standards mandated by the HIPAA Transactions and Code Set Rule (TCS).
The TCS is tasked with creating standards for electronic information exchanged between healthcare providers and insurance companies covering costs. Typically, there are two ways to submit claims – either a hard copy or an electronic copy of the bill. Forms may be auto-filled using software. And if any of the information transferred is coded differently than what the payer expects to see, the claim will be denied.
In order to reduce the time the bill is sent and payment received, all information needs to be accurate and understood by the insurance company. These are considered clean submissions.
This software method checks all the electronic fields are filled with the proper data. For instance, it checks a social security field and verifies there are 9 digits. It also checks to ensure the NPI, the ten digit physician identifier code, is in its proper field.
Some scrubbers check the coding, the procedure, and the bundling information. Others check the local CCI rules and Medicare requirements.
Dynamic Proprietary Scrubber
Each insurance company has its own set of rules for submission. And data scrubbing software may be created specifically for their use. When scrubs are used in this fashion, the claim submissions are more productive and payments released quickly.
There are times when insurance plans change. The billing office may update the scrubber to filter claims and fix problems prior to submission. These scrubbers can reduce a great deal of frustration and extra time spent on collection.
When the healthcare provider creates billing for an insurance company, a clearinghouse may be used. It takes the original bill and formats it to ensure a quick payment schedule. Basically, it scrubs all the information to eliminate processing errors. A clearinghouse charges for each claim submitted.
Each clearinghouse is geared toward particular payer processing software. So a bill may actually be forwarded to a second clearinghouse for final submission.
An enrollment period is necessary when first setting up the billing process with a clearinghouse. It can take around a month to ensure compatibility of software between the healthcare provider and insurance company.
Regardless, all information submitted must be understood to receive payments. Data scrubbing everything involved is the best way to make sure your claims are in order.