doctor reviewing medical claims

Maximizing Revenue: The Importance of Reviewing Claims Before Submission

Why Should You Review Claims Prior to Submission?

In a perfect world, every single claim your practice sent to insurance companies would be flawless, and you’d get paid promptly for all the services you deliver without any hiccups. As a healthcare provider you know too well, that’s almost never the case, but you might get closer to that goal if you review claims prior to submission. 

According to a recent report from Change Healthcare, 11.1 percent of all healthcare claims are denied when they’re initially submitted, a 23 percent increase since 2016. Unfortunately, the average healthcare provider spends $118 appealing each individual claim that isn’t approved the first time around. 

Yet, the same report reveals an encouraging statistic: a staggering 86 percent of claim denials are preventable. Given that a quarter of initially rejected claims remain unrecovered, the imperative for preemptive action becomes evident.

Enter claims scrubbing technology—a straightforward remedy to this predicament.

What Is Claims Scrubbing? 

Through the process of claims scrubbing, practices use software or a service to review claims prior to submission to insurers to check that they’re accurate. By doing so, healthcare practices increase the chances that each claim is paid out in a timely manner and that the revenue cycle management process is optimized.

According to the American Medical Association, the most common medical coding errors are as follows:

  • Unbundling codes 
  • Upcoding 
  • Failing to ensure claims align with the National Correct Coding Initiative 
  • Using modifiers incorrectly 
  • Overusing modifier 22 
  • Reporting injection codes improperly 
  • Reporting infusion and hydration codes improperly 
  • Using unlisted codes without documentation  

As you can see, there are a lot of opportunities for potential errors to make their way into claims.  

Historically, medical practices had to facilitate the claims scrubbing process by hand. Luckily, in the digital age, practices can accelerate this process by either investing in technology or outsourcing the responsibility entirely to an expert billing team. 

Why Is Claims Scrubbing Important? 

At the highest level, claims scrubbing is important because it enables practices to get more control over their cash flow and speed up payments by drastically reducing the likelihood errors are sent to insurance companies.

Additionally, claims scrubbing prevents employees from having to spend significant amounts of time reviewing rejected claims. Whether your practice invests in digital tools to expedite the process, or you decide to outsource claims scrubbing entirely, your team will reclaim significant amounts of time by review claims prior to submission and then invest in other critical areas of practice operations.

For example, instead of spending hours dealing with claims scrubbing each week, staff can spend more time focusing on delivering patient-centric care, which helps enhance the patient experience, reduce churn, and bolster your bottom line. 

Healthcare administrator using revenue cycle management software
Healthcare costs and fees concept. Top view of smart doctor calculating medical costs in modern hospital. Doctor completing a Medical Claim Form ,Stethoscope

How Claims Scrubbing Helps You Get Paid Faster 

By modernizing your practice’s approach to claims scrubbing, you can speed up payments and ensure your practice has the cash it needs to continue treating patients effectively while ensuring staff have the resources they need to do their best work.

With that in mind, here are four distinct ways claims scrubbing can help your practice get the money you’ve earned faster. 

1. The claims scrubbing process is wrapped up quicker 

When your team is responsible for scrubbing claims by hand, the process is often a long and grueling one. In an age where there’s a digital solution to everything from hailing a cab to ordering groceries, employees tasked with manually scrubbing claims are unlikely to be thrilled by the endeavor. 

By investing in a purpose-built, digital claims scrubbing solution or hiring an expert team to handle all of your billing needs, the claims scrubbing process takes considerably less time, which means you’ll be able to submit claims faster — and, by extension, get paid faster, too. 

2. Changes can be made ahead of submission

With the right claims scrubbing solution in place, all problem claims will be flagged ahead of time. That way, your practice can rectify errors immediately — prior to the submission of claims to the insurance company. Instead of waiting for weeks only to learn the hard way your claims have been denied and then having to resubmit them, you avoid that scenario entirely, and payments are sped up because of it. 

3. Claims can be submitted quickly (e.g., daily vs. weekly) 

Many practices wait until a specific point in the week to send all their claims at once. In these scenarios, payments are delayed because insurance providers aren’t receiving them in a timely manner. If your practice sees a patient on Monday but doesn’t submit the associated claim until Friday, payment will be delayed by at least four days in the best-case scenario. 

When you take a modern approach to claims scrubbing, it’s much easier to ensure that all claims are submitted the day services are rendered. By sending out claims on a daily basis, you ensure that your practice is paid as fast as is possible from your end. 

4. Claims can be submitted electronically 

In the digital age, it comes as no surprise that claims that are submitted electronically are generally paid faster than claims submitted the old-fashioned way. By investing in a claims scrubbing solution or partnering with an expert billing team that uses the latest tools, you can ensure that all of your claims are submitted electronically — which should speed up payment. 

Overcome Cash Flow Problems with Claims Scrubbing Solutions! 

Relying on outdated claim submission methods inevitably results in undue time expenditure and increased claim rejections. By embracing advanced practice management software and partnering with proficient billing teams, practices can ensure timely reimbursement, safeguarding financial vitality.




Related Blog Articles