scrubbing claims
When a patient comes in to see the doctor, we post the service(s) on the ledger in the form of line items. These services are then billed to insurances and/or medical plans. Every day, our finance team double checks every single line item that is posted in our ledgers to ensure they are 100% correct and ready to bill to insurance. They also double check the patient’s insurance information on their chart to ensure a smooth claim billing experience. This process is called “scrubbing claims,” and in this module, we will list how this task is completed and common errors that you must look for when scrubbing claims.
To get started on scrubbing claims, you will pull up the previous day’s schedules. (On Monday, you will need to pull up Friday and Saturday’s schedules). You will need to complete scrubbing for all doctor’s and threshold schedules at all locations for that day, so choose an office and doctor’s schedule to start with, complete the following steps, and then continue through until all doctor and threshold schedules at all locations are completed.
On the doctor’s schedule, select the first patient, and right click. Select “Go To Patient,” and then “Demographics.” This will take you to the patient’s demographic screen.
On the patient’s demographic screen, you will want to double check that the plan shows an insurance that is not expired in their insurance list and that the provider listed is the last doctor that the patient saw.
Go to the patient’s insurance section and double check that each active (not expired) insurance is completely filled out with the correct name, DOB, gender, relationship to patient, and policy + group numbers. Double check that the scanned insurance card matches the numbers in the policy and group number fields. Also look what copays the patient may have (look for the copy listed for specialty).
Once all of that is correct, go to the patient’s EHR record, and go to the routing tab. On the routing tab, look at all of the services that are checked and should be billed, and then go to the ledger to double check that each of those service codes are in fact posted on the ledger. If any are missing, add them now and change the service date to the date the service was performed.
Next, on the patient’s ledger, you will double check EACH line item for that date of service. Double click on each line item and check that:
the correct doctor’s initials are listed for that line item
the diagnosis code is listed and correct
the correct copay was collected if the patient had a copay
the correct amount is being billed to the insurance company
No need to adjust/fix copays at this point, as when it is billed to the insurance, it will reflect on the EOB and a statement will be sent.
Then, click on the patient’s appt for yesterday (or the day you are working on), and select the next patient on the schedule.
Repeat this process until all patients accounts have been scrubbed, then move onto the next doctor until all doctors at all locations are completed!
COMMON ERRORS:
No or incorrect billable code.
When the code is incorrect on the ledger line item, open the line item, and then click “expand.” Add the correct DX code or rearrange the Dx to be correct.
Then click “Claim Validation” to see if it will process correctly. If there are additional errors, it will tell you and you can fix it.
Thresholds NOT being posted or being posted without DR initials are some of the most common errors seen during scrubbing. To fix, either post the threshold, and make sure to change the initials on the line item to the last dr they saw instead of leaving it as THR.
Another common issue is missing information in the insurance screen on the patient’s demographic. Make sure ALL of the required information is there!