Advanced Clinical Editing Software Takes Claims Scrubbing to a New Level

Denied claims are a large source of lost revenue for many healthcare organizations. Yet, physician practices often lack the resources to process them in a timely fashion. It is important for claims to be submitted accurately and error-free the first time around, to avoid revenue cycle setbacks and ensure timely reimbursement. One way to accomplish this is by using a medical billing EMR or practice management software with built-in claims scrubbing capabilities.

Claims scrubbers analyze the data attached to a claim to ensure that all required data is present before the claims is submitted to the payer. This includes patient demographics, insurance information, procedure and diagnosis codes, and date of service. It is important to note, however, that not all claims scrubbers offer the same features and functionalities. In fact, while a basic claims scrubber might check that certain fields are filled out on the claim, it might not verify the accuracy of the entered data. Therefore, it is important to use a claims scrubbing system with advanced capabilities.

It is also helpful to rely on software that uses the same tools as the major insurance carriers, meaning that if a payer’s tool is updated your practice gets the same update as well. This allows healthcare professionals to fully identify errors that an insurance carrier might catch, thus avoiding a delay in payment.

With 1st Providers Choice’s Advanced Clinical Editing electronic claims software, not only can billing staff submit clean claims the first time, reducing denials and rejections and increasing revenue, but partially-billed procedures can also be corrected in order to ensure maximum reimbursement. Through automated alerts, staff can be notified when edits might be necessary, and they can also review any guidelines and regulations that may have triggered the alerts.

Additional features and benefits of our advanced claims scrubbing software:

• Integrate superior clinical editing features into existing claims management workflow
• Actively track, control and prevent denied claims
• Streamline claims editing with our extensive knowledgebase of coding relationships (from commercial payers to Medicare)
• View multiple claims rules on the same screen
• Increase efficiency and revenue with electronic billing

For more information about our electronic claims software and how it might benefit your healthcare organization, contact us at 480-782-1116.