Optimize Medical Claims With Cutting-edge Scrubbing Software
Medical Claims Scrubbing Solution Improves Revenue Flow
What is the Purpose of Medical Claim Scrubber Software?
One of the most important aspects of medical billing is the ability to process claims quickly. Nonetheless, it negatively affects the revenue flow if quick processing results in repeated denials.
Claim scrubbers can improve revenue flow by ensuring the accuracy and integrity of medical claims. PrognoCIS Medical claims scrubber Solution is designed to review and validate claims for potential errors, discrepancies, or missing information before they are submitted for processing. By systematically checking claims against various predefined rules and industry standards, claims scrubbers help identify and correct errors improve claim acceptance rates, reduce claim denials, and enhance overall revenue cycle management.
Additionally, claim scrubbers can assist in identifying coding or billing issues, compliance violations and potential fraud or abuse, thus promoting regulatory adherence and financial efficiency in healthcare organizations.
What Are the Benefits Of Using A Medical Claims Scrubber?
1. Increased Claim Accuracy: A medical claims scrubber helps identify errors and inconsistencies in claims before submission. By validating claims against industry standards, payer-specific guidelines, and coding requirements, it improves claim accuracy, reducing the chances of denials and rejections.
2. Reduced Claim Denials: Claims scrubbers catch potential errors and issues in real-time, allowing for timely corrections. By addressing these issues before submission, healthcare organizations can significantly reduce claim denials and rejections, leading to faster payment and improved cash flow.
3. Improved Revenue Cycle Management: Accurate and clean claims facilitate a smoother revenue cycle. PrognoCIS Medical Claims scrubbing software helps to optimize the billing process, streamlining workflows, reducing manual errors, and minimizing the need for rework. This efficiency leads to faster claim processing, quicker reimbursements, and overall improved financial performance.
4. Compliance Adherence: Medical claims scrubbers incorporate compliance checks to ensure claims adhere to coding and billing regulations. By validating codes, identifying compliance issues, and providing alerts for potential violations, the scrubber helps healthcare organizations to maintain regulatory compliance, reducing the risk of audits and penalties.
5. Enhanced Productivity: Claim scrubbers automate the claim validation process, saving time and effort for billing staff. But automating routine checks and flagging potential errors, the software allows staff to focus on exception handling and resolving more complex issues. This increased efficiency boosts productivity within the billing department.
2. Reduced Claim Denials: Medical Claims scrubbers catch potential errors and issues in real-time, allowing for timely corrections. By addressing these issues before submission, healthcare organizations can significantly reduce claim denials and rejections, leading to faster payment and improved cash flow.
4. Compliance Adherence: Medical claims scrubbers incorporate compliance checks to ensure claims adhere to coding and billing regulations. By validating codes, identifying compliance issues, and providing alerts for potential violations, the scrubber helps healthcare organizations to maintain regulatory compliance, reducing the risk of audits and penalties.
6. Cost-Saving: Efficient claim scrubbing reduces the need for manual intervention and rework. By catching errors early on, organizations can avoid costly claim re-submission, appeals and additional administrative overhead. The software identifies underpayments and missing revenue.
PrognoCIS' Medical Claim Scrubber: Here's What We Offer
Claim Scrubbing and Validation
Code Validation and Compliance
Real-Time Claim Status and Tracking
Rules Engine and Customization
Claim Analytics and Reporting
Integration and Workflow Efficiency
Regulatory Compliance and Industry Updates
Claim Scrubbing and Validation
Code Validation and Compliance
Rules Engine and Customization
Real-Time Claim Status and Tracking
Claim Analytics and Reporting
Integration and Workflow Efficiency
Regulatory Compliance and Industry Updates
What is the Purpose of Claim Scrubbers?
One of the most important aspects of medical billing is the ability to process claims quickly. Nonetheless, it negatively affects the revenue flow if quick processing results in repeated denials.
However, PrognoCIS’ claims scrubber software can improve revenue flow by quickly, and accurately creating squeaky-clean claims.
With claim scrubber software, instead of spending time investigating and then addressing denials, staff can improve each patient’s overall experience.
What Are the Benefits of Using a Medical Claims Scrubber?
Faster Payment
The quickest way to improve revenue flow is by submitting an error-free medical claim.
Claim Scrubbing in Medical Billing Helps Prevent Denials
After a claim denial, the provider must correct and resubmit the claim in a timely manner. A clean claim in medical billing helps prevent insurance denials, consequently, using claim scrubbers improves revenue flow.
Eliminates the Need for Manual Claim Scrubbing
The customizable, practice-specific claim scrubbers that PrognoCIS’ medical billing software provides eliminate the need for manual claim scrubbing. In addition, using well-designed claim scrubber software makes it possible to achieve a first pass ratio of as much as 97 percent.
Overlooked Denials Result in Lost Revenue
With PrognoCIS software if there is a denial, the likelihood of receiving the highest payment possible increases.
Here is why:
Fewer denials usually make it easier for staff to quickly fix and resubmit claims.
Reduce Claim Status Inquiries to Increase Profit
According to the 2019 CAQH INDEX®, just inquiring on the status of a single claim costs $7.22. PrognoCIS’ claim scrubber software allows staff to submit clean medical claims and, as a result, decrease the frequency of inquiries.
PrognoCIS Medical Claim Scrubber: Here's What We Offer
PrognoCIS’ software supports built-in scrubbers to ensure clean claims:
- Date validation for code sets
- Built-in date validation for ICD, HCPCS, and CPT code sets decreases the number of claim denials resulting from outdated and improper coding.
- Automatic Medicare National Correct Coding Initiative (aka NCCI or CCI) edits:
- The automated NCCI procedure-to-procedure (PTP) code pair prevents the hassle of receiving an incorrect payment amount for services covered under Medicare Part B.
- Validation of claim information regarding the patients:
- Age and gender-specific diagnosis codes.
- PrognoCIS’ claim scrubber software also offers:
- Customizable local and national coverage determinations (LCD/NCD) for select specialties and states.
The denial analysis report in PrognoCIS RCM helps identify denial trends that need to transpose into a scrubber check to prevent future denials.
Utilizing claim scrubbing software or outsourcing the services to a revenue cycle management vendor, reduces the turnaround and boosts the revenue flow.
