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In the healthcare industry, the process of submitting claims to insurance providers is a critical step in ensuring that healthcare providers are reimbursed for their services. However, manual claim scrubbing, while important for checking the accuracy of claims, can significantly increase submission delays. These delays can have a ripple effect, impacting cash flow, administrative efficiency, and ultimately, the provider’s relationship with both payers and patients.

In this article, we will delve into the role of manual claim scrubbing, its impact on claims submission timelines, and how automation and other strategies can help reduce delays while ensuring accurate claims submissions.

What is Manual Claim Scrubbing?

Claim scrubbing is a process in which submitted claims are carefully reviewed to ensure that all required information is accurate, complete, and conforms to the payer’s standards before being sent for payment processing. Manual claim scrubbing typically involves a healthcare administrator or billing specialist manually reviewing each claim to check for errors, omissions, or inconsistencies in key areas such as:

• Patient demographics (e.g., name, date of birth, insurance information)

• Diagnosis and procedure codes (ICD-10, CPT)

• Insurance details (e.g., policy number, group number)

• Billing and service dates

While this process is necessary to prevent claim denials due to simple errors, the manual nature of the process can lead to increased delays, errors, and administrative burden, particularly in busy healthcare practices.

How Manual Claim Scrubbing Contributes to Submission Delays?

1. Time-Consuming Process
   Manual claim scrubbing is inherently slow and time-consuming. Billing specialists must carefully inspect each claim for errors and verify that all fields are filled out correctly. With the sheer volume of claims processed in a typical healthcare setting, this manual review can significantly delay the submission of claims, which in turn delays the reimbursement process.

2. Human Error
   While manual scrubbing is designed to catch mistakes, it is still prone to human error. Billing specialists can overlook minor details, leading to rejected claims or incomplete submissions. This forces staff to rework claims and resubmit them, further delaying the entire process.

3. Inconsistent Scrubbing Standards
   Manual claim scrubbing is highly dependent on the skill and knowledge of the individual performing the task. Variations in scrubbing standards across different staff members can lead to inconsistent results. Some claims may receive a more thorough review than others, leading to some claims being submitted with errors while others are correctly processed.

4. Backlog of Claims
   Healthcare providers that rely on manual claim scrubbing often face a backlog of claims waiting to be reviewed. This backlog can delay the submission of claims, making it difficult for providers to maintain a steady cash flow. In some cases, claims may miss payment deadlines, resulting in delayed reimbursements or penalties.

5. Lack of Real-Time Feedback
   Manual claim scrubbing doesn’t provide real-time feedback, meaning that issues with claims often go unnoticed until after the submission. This delay in identifying errors can result in denials, requiring claims to be returned for correction and resubmission.

The Impact of Increased Claims Submission Delays

1. Cash Flow Disruption
   One of the most significant consequences of delayed claims submissions is the disruption of cash flow. When claims are not submitted in a timely manner, healthcare providers experience delays in receiving reimbursement. This can make it difficult to meet operational expenses, pay staff, or invest in patient care improvements.

2. Increased Administrative Costs
   When claims are delayed or rejected, additional administrative work is required to resubmit them. This often involves revisiting the original claim, correcting errors, and resubmitting it for processing, which increases the workload for billing and coding staff. In turn, this leads to higher administrative costs for the healthcare organization.

3. Patient Satisfaction Issues
   Delayed claims can lead to billing errors or confusion, causing frustration for patients. If a claim is not submitted promptly, patients may receive unexpected bills or have difficulty understanding their financial responsibility. This can lead to dissatisfaction and, in some cases, damage the provider’s reputation.

4. Denials and Rejections
   Claims that are not scrubbed in a timely and thorough manner are at risk of being denied or rejected by insurers. The denials may be due to issues such as incorrect coding, missing information, or eligibility mismatches. Once a claim is rejected, the provider must spend additional time and resources addressing the issue and resubmitting the claim.

5. Compliance Risks
   Inaccurate or incomplete claims submissions, even those arising from manual scrubbing errors, can lead to compliance risks. Healthcare providers are required to submit accurate and compliant claims for reimbursement. Failure to do so could result in audits, penalties, or even legal action, depending on the severity of the issues.

Solutions to Reduce Claims Submission Delays

1. Automation of Claim Scrubbing
   One of the most effective ways to reduce delays in claims submission is by automating the claim scrubbing process. Automated systems can quickly and accurately review claims, flagging errors or omissions before submission. These systems are faster and less prone to human error, allowing claims to be submitted more quickly and with fewer mistakes. Automated claim scrubbing also offers real-time feedback, enabling immediate corrections to be made.

2. Integrated Billing and Coding Software
   Using integrated billing and coding software can streamline the entire claims process. These systems help ensure that the correct codes are used and that all required fields are filled out properly. Integrated software can also interface with payer systems to validate claims in real time, ensuring that all information is accurate before submission.

3. Staff Training and Standardization
   Regular training for billing and coding staff is essential to minimize errors and improve efficiency. By standardizing the scrubbing process and ensuring that all team members are well-versed in the latest coding standards and payer requirements, healthcare providers can reduce inconsistencies and improve the speed and accuracy of manual claim scrubbing.

4. Outsource Claim Scrubbing
   Another option is to outsource the claim scrubbing process to specialized third-party services. These services often use advanced technology and have teams of experts dedicated to ensuring that claims are scrubbed efficiently and accurately. Outsourcing claim scrubbing can help reduce the burden on internal staff and accelerate claims processing.

5. Real-Time Claims Processing
   Partnering with insurers that offer real-time claims processing can further reduce delays. Real-time claim submission platforms allow claims to be processed and reviewed as soon as they are submitted, helping healthcare providers receive feedback and corrections quickly. This system ensures that claims are submitted without delay, reducing the risk of errors and rework.

What Did We Learn?

Manual claim scrubbing is an essential process for ensuring that healthcare providers are paid for their services. However, when performed manually, it can lead to significant delays in claims submission, impacting cash flow, administrative efficiency, and patient satisfaction. By leveraging automation, integrated billing software, regular staff training, and outsourcing, healthcare providers can streamline their claims submission processes, reduce delays, and ensure that claims are submitted accurately and on time. These improvements not only enhance operational efficiency but also help to maintain a steady cash flow and avoid the administrative costs associated with rejected or denied claims.

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