Let's look at Claim Scrubbers and how they function to optimize reimbursement of medical claims.

Let's look at Claim Scrubbers and how they function to optimize reimbursement of medical claims.

The best medical billing software will have a built in scrubber that analyzes the procedure codes on the claim for any conflicts to the NCCI edits.

If the scrubber finds no conflicts, then you can proceed with submitting your claim without any changes or corrections.  If the scrubber does show conflicts between two or more codes, then you now have the opportunity to review and adjust your claim before it is denied.

The billing software should indicate why there is a conflict and maybe all that is needed is a modifier.  For example, if it states one procedure is a component of the "larger" procedure, you know to not submit the component procedure.

When you submit a claim that is denied based solely on lack of a proper modifier, you then have to resumbit a "corrected claim".  Even thought they are indicated as a "corrected claim", you can now enter the duplicate claim denial loop. You may end up waiting months for reimbursement and wasting countless hours working with the payer to get the claim paid.  By taking a few minutes to "pre-check" the claim, all this would be avoided.

Investing in a medical billing system with an integrated claims scrubber you will see greater and faster returns in the reimbursement of medical claims.