Not all medical claim scrubbers are created equal

Scrubbing claims can save your practice thousands of dollars. How?

The average denial costs $45 to fix and resubmit, according to the MGMA. And if, as insurance companies hope, you forget to fix it, you've just given them a present. Worse yet, perfectly valid claims are sometimes denied in error ("No, really?" "Yes, really!")

The earlier you find a problem with a claim, the easier it is to fix.

The worst case, of course, is getting a denial, possibly weeks after the claim was submitted.

The best case is to be told right when you finish entering a claim. The paperwork is right there in front of you, and the case is fresh in your mind. Some practice management software packages have scrubbing built right in. If yours does, you should make sure you are using it.

If your software doesn't have a scrubber, an online one is the next best solution.

The Coding Advisor's online claim scrubber allows you to enter partial claims, so you can quickly check to see if the claim you are about to submit has problems.

If you're worried about whether the procedures on a claim can go together (that is, if there is a potential unbundling problem), just enter the procedure codes. The Coding Advisor will tell you if you need a modifier to get the claim through, and will even suggest which modifiers are applicable.

If you're wondering if the diagnoses associate with a procedure satisfy your locality's medical necessity criteria, just enter the procedure and it's diagnosis codes. The Coding Advisor will tell you if there is a problem. It will even give you the documentation for your locality that explains the medical necessity criteria (that's the LCD or the NCD), which includes the list of diagnosis codes that will pass the medical necessity test.

Don't wait until later to find out if your claim has a problem. Find out on the spot! It will save you time and aggravation.

 


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