Medical
Billing Best
Practices # 5
Medical Claims: - Filing Claims Electronically /
Rejections / Claim Scrubbing
Let's us
first state that this, and the previous section on 'preparing claims' is
the 'HOW TO DO IT PART' of the how to do it.
And
we'll start with the assumption that all claim errors are avoidable.
Most
medical billing is fairly repetitive so given ample training, decent
billing software, decent coding tools, and a decent clearinghouse, a
healthy amount (90%) of your claims should be clean. So what causes a claim to
be rejected?
CLAIM
REJECTIONS
Claims can be rejected for
a number of reasons but the most common reasons are typos and lack of
double checking and scrutinizing the claim before it's sent; in other
words - Human Error - or a lack of conscientiousness. In fact the top ten items
are totally ordinary stuff like a wrong date of birth entered and what not.
So let's
assume for the moment that we've been given ample training, have decent billing
software and decent coding tools, and that we have a decent
clearinghouse. It is the clearinghouse that comes into play at this
point in the way of claim scrubbing.
CLAIM
SCRUBBING:
Without
going into detail of what a clearinghouse is, claim scrubbing, or claim
analysis is by far
the most significant thing that a clearinghouse does. Using software it catches the thousands (that's right, thousands) of things that can
cause an insurance claim to contain errors and be rejected. Catching it
here before it hits the insurance carrier keeps it
from being rejected, prolonging the revenue
cycle. Clearinghouses will tell you within minutes or hours whether a claim has
errors on it or no. Some expensive billing software (normally referred
to as Practice Management software), will have these sophisticated
feature like claim scrubbing integrated within their software working
behind the scenes catching errors before the claim is sent to the
carrier!
ELECTRONIC
FILING OF CLAIMS
In
the medical billing field nothing is more mysterious that how claims
are transmitted electronically. In our case fortunately it is not as
important to understand are the technological nuances as it is to know
what to do and how to do it.
Normally
the Medical Billing Software at the practice is hooked up to send and receive
claims transmissions. This is normally done through a clearing house,
but is sometime done through a direct connect - say to Medicare or
Medicaid. Here is an excellent article on clearinghouse - what they
are and what they do.
For
our purposes, we will focus on the basics of how to create a claim,
how to create an electronic file, and how to 'upload it' to the
clearinghouse.
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