Claims Scrubbing

At RCM we target at getting every claim paid in the first submission. To be more successful in doing this we have a three level scrubbing in place.

The First Level — coding — With the set of highly qualified and experienced certified coders who have hands on experience in all specialties we check on each document to see if the codes are correct. We know most doctors know the codes but where they miss out is on checking if the DX is consistent and payable with the procedure. Our coders look at the codes in a more of a reimbursement approach to make sure it is billed correctly at the first place.

Level Two — QC — When the coding is complete and the charges are entered the claims go thru a quality check. These claims are checked by specialists who are more qualified and experienced than coders. They quick run to see the codes and to see if the POS, the patient gender, the modifier and all other details are correct so that each line gets reimbursed. They look at everything it takes to get the claims clean the first time.

Level Three — software/Clearinghouse — This is mostly the only place where most practices fix the errors. But we hardly find any errors here, still as a part of the process we check to see if the Clearing house acknowledges the claim and so does the payer. We in our experience have seen a lot of clients who don’t even know that this exists. They assume that once a claim is submitted it goes to the payer and when this is unattended this becomes a large part of the noncollectable over a period of time. We can proudly say that with these in place there is rarely any claim that gets denied for reasons related to coding.