How to Earn Fast with Claim Scrubbing and Error Prevention?

Have you ever noticed some practices recover revenue fast from dental billing, while others lose revenue due to claim denials? 

The secret lies in claim scrubbing. It’s a key aspect in your dental billing process, which catches errors in your claim submissions. With claim scrubbing, billers correct these mistakes and submit clean claims for fast and complete reimbursements.

Want to know how using dental billing services with claim scrubbing helps your practice maximize collections and save time spent in fixing denials?

Let’s discuss!

What is Claim Scrubbing?

If you’ve unfamiliar with the term “claim scrubbing”, we’ll help you understand this in a simple way.

The thing is that insurance companies expect you to submit complete and clean claims. They don’t expect even a single missed digit or incorrect spelling. Whether you’re entering patient data, procedure code, or treatment details in your claim form, everything should be accurate. 

Claim scrubbing helps with that. It makes your entire dental billing and coding process clean by finding errors, like:

• Incorrect CDT codes
• Incomplete documents
• Spelling mistakes
• Inaccurate patient details

Once you find these errors, you can correct them in your claim forms and submit claims that insurance companies approve, resulting in faster reimbursements for your practice.

How Does Claim Scrubbing Fix Errors?

Let’s explore how the claim scrubbing process works in dental billing.

Reviews Entered Details

In claim scrubbing process, all details are checked in dental claim forms including:

• Patient data (name, date of birth, subscriber ID, etc.)
• Provider data (NPI number, practice address, etc.)
• Date of service
• Insurers’ accepted CDT code for procedures
• Details of treated tooth (Tooth number, tooth system, tooth surface etc.)

Checks Documentation Requirements

Each insurance company or Medicaid/Medicare state plan defines its own requirements for documents needed in a claim form for a dental procedure. 

For example, an insurance company may require its own documents for root canal therapy, while another insurer may define its own requirements.

Claim scrubbing process checks if the documents are complete and correct according to insurers’ expectations. If the attachments don’t match insurers’ requirements, claim scrubbing flags it.

Evaluates Insurance Coverage

Claim scrubbing checks if the submitted claims match insurance coverage details. It reviews a patient’s insurance coverage plan, checking available benefits, non-covered services, frequency limitations, and age restrictions for claim submissions.

If there is any discrepancy, scrubbing flags it.

Example: A patient’s insurance plan allows two cleanings per year. The patient has received two cleanings for that year, which means that their coverage has expired, and insurance doesn’t entertain the third cleaning. If the patient visits you for the third cleaning and you submit a claim for that, claim scrubbing immediately catches it and notifies that the third cleaning isn’t allowed.

A similar example is of the coordination of benefits, where a patient has subscribed to two insurance plans. Claim scrubbing checks the COB logic and flags if claims are submitted in the incorrect order.

Prevents Duplicate Claims

Sometimes, you may experience a scenario, where your billing team mistakenly submits claims twice for a dental procedure. Claim scrubbing checks and prevents duplication for the same claim by flagging it as already submitted.

Detects Pre-Authorizations

Insurance companies require practices to request prior authorizations for some costly and complex dental procedures. Insurers want practices to seek their approval before filing a claim. And these companies publish manuals, in which they list down the procedures, which require pre-authorization.

Claim scrubbing prevents claim denials, protects revenue, and saves time spent in appealing for claim denials. 

It does that by checking if the insurance company requires pre-authorization for a dental procedure. If you’ve submitted a claim without requesting pre authorization and receiving insurer’s approval for that, scrubbing flags it as an error.

Ways to Scrub Dental Claims

There are two primary ways through which you can scrub your dental claims: electronic and manual.

Electronic Claim Scrubbing

Automatic claim scrubbing tools are used to scrub claims electronically. These tools outperform manual scrubbing processes in a lot of ways.

Batch Scrubbing

Claim scrubbing tools scrub multiple claims at a time, checking them against insurance policies, CDT coding fundamentals, and patient demographics. These tools scrub these claims within seconds while manual processes take anywhere between 5 to 15 minutes.

Clinical Edits

Automated claim scrubbing checks clinical details of a dental claim. For example, if you’re submitting a claim for dental sealants on patients, it checks if it’s suitable for the patient’s age, or if insurance covers it for the patient. The thing is that insurers often set frequency limitations on dental sealants for adults.

Speed and Accuracy

As we’ve just mentioned, scrubbing tools check fields in claim forms within just a few seconds. And these tools provide near-accurate results, as compared to manual processes, which may result in errors.

Easy Integration

Scrubbing tools easily integrate with your dental billing software, whether you’re using a practice management system or an EHR tool. And if your EHR tool is integrated with your payer portals, it helps with smooth and effective claim scrubbing.

As soon as you enter patient details in your EHR system, this integrated scrubbing feature matches patient demographics and coverage plan details with the payer data. After that, it checks the claim data and flags if there are any errors.

And there is one thing to note that some billing systems offer built-in claim scrubbing features, where you don’t need to invest in two separate systems.

Insurer Compliance

Scrubbing tools assist you with dental billing compliance. These tools work according to insurance companies’ set requirements for each claim and procedure. They check if you’ve entered their accepted CDT codes, attached their required documents, followed the payer contract rules or state Medicaid dental policies, and fulfilled other requirements.

If your claim complies with regulations, it passes for submission, and if it doesn’t comply, scrubbing flags it and requires fixes.

Predictive Analytics

New claim scrubbing tools have built-in AI automation and machine learning capabilities, through which these tools use predictive analytics in their process. These tools review patterns of past claims, analyze them, and flag errors. 

For example, whether your past claims are successfully reimbursed or denied by insurers, these claims review patterns. These note the factors which qualify these claims for submission, and also check denial reasons. Based on that, these check fields and make or suggest corrections.

Claim Score

Once claim scrubbing is complete, the tools rate a claim as:

• Clean or low-risk, and ready for submission
• Incorrect with errors requiring fixes

If a claim is clean for insurer approval, it automatically passes through integrated claim scrubbing in a PMS, and the system submits your claim.

Manual Claim Scrubbing

The other way to scrub claims is to check claims manually, detect errors, and correct them for clean claim submissions. In manual processes, insurance claim scrubbers or claim processors check dental claims. They perform in-depth audits, viewing if:

• Claims are compliant
• Entered data is accurate
• All documents are attached

While industry experts scrub claims, it takes a lot of time per claim, and even many minutes for complex claims. And even then, mistakes can be a part of the process, something which is much less in automation.

What’s the Better Approach?

As we’ve discussed, manual claim scrubbing takes minutes per claim, which means that if your staff scrubs more claims, they can’t check beyond a certain number that day. But, automation features like batch scrubbing and predictive analytics check multiple claims at a time and review past patterns to predict what insurers approve.

Now, based on it, it’s up to you, whether you want to automate claim scrubbing or follow manual processes to fix errors.

Does Claim Scrubbing Benefit Your Practice Revenue?

Claim scrubbing leaves a huge impact on your practice revenue. Let’s review how scrubbing your dental claims benefits your practice.

Improved Clean Claim Rate and Faster Reimbursements

The primary benefit of scrubbing your dental claims is that your practice has an impressive first-pass approval rate. It’s because when you check and fix errors, your claims are clean, which insurers quickly reimburse. The ratio of denials is lesser.

Better Staff Productivity

When insurance companies deny your claims, your staff has to spend a lot of time checking and fixing claim denials, and then submitting appeal requests to insurance companies. And since claim scrubbing checks errors before submission and prevents denials, it saves your staff’s valuable time. They can spend it on other important tasks, such as offering quality care to patients.

Efficient A/R Management

As we’ve discussed, claim scrubbing improves claim approval rates, which means that your revenue doesn’t get stuck. It helps prevent A/R aging and write-offs, which are a big reason for revenue loss for dental practices.

The result is that if you have any outstanding balances left from any unpaid insurance claims or patient bills, A/R teams can easily control and recover much of the remaining amount, with a strategic approach.

How to Make Claim Scrubbing Effective for Faster Payments?

Maintain Accurate Patient Data

When patients book an appointment at your practice for a treatment, verify all their details, including their:

• Demographics (name, date of birth, subscriber ID)
• Insurance coverage data (benefits, frequency limitations, co-pays, and deductibles)

Whether you scan through payer portals or contact insurers directly, make sure the data is accurate. 

The best way to do so is using services, such as TransDental’s real-time insurance eligibility verification, which provides you with correct data at the time of check-up. You can maintain these records in your database or systems to improve claim scrubbing for efficient results.

Update Your Billing Software

If you’re using a billing software for automated claim scrubbing, update payer policies, latest CDT codes, and all the other requirements, as soon as changes occur. With that, your systems scrub claims by complying with these policies to assist you with submitting claims, which payers approve.

Use Scrubbing Reports to Improve Processes

When your systems scrub claims, these generate reports, which contain all the highlighted fields containing errors. Use these reports and see common errors in each claim, and train your billing staff. Highlight weak areas and guide them to improve processes, so these mistakes aren’t repeated.

Scrub Every Claim

Sometimes, your billing staff may scrub just complex claims, and ignore simple claims without checking errors. And if these simple claims contain errors, it results in denials and headaches of appealing for denials.

To avoid that, scrub every claim for errors, whether it’s simple or complex, so your claim is clean for submission and approval.

Fix Errors Instantly

When you receive errors in claims after scrubbing, fix them immediately, re-check claims, and submit them. It’s easy to fix claims instantly, as your billing staff has available information, but it’s difficult to remember each detail later on.

Outsource Claim Scrubbing

Scrubbing your dental claims in-house can be stressful for your staff, and consume much of their valuable time. After all, reviewing every single claim and checking each field and attachments in a claim form is not an easy task. And paying huge salaries for the task can increase your practice’s overhead.

The best solution? Partner with a reliable dental billing company that manages your claims from the very start. Whether it’s verifying patient data with insurers and filling correct claim forms, or checking every single claim before submission and submitting clean claims, an outsourcing partner like TransDental does that very well.

Outsourcing companies charge you very less at what you recover per claim (not more than 4-5%!), and deploy AI automation with certified dental billers with a track record of recovering millions of dollars for dental practices with error-free claims. And they can scrub multiple claims at a time, speeding up submission and reimbursement.

Conclusion

Claim scrubbing is the key to submitting clean claims and getting faster reimbursements from insurance companies. It prevents claim denials, saves your staff time, and helps maximize your practice collections to boost revenue growth.

Frequently Asked Questions (FAQs)