Scrubbing claims is the process of verifying the accuracy of a medical billing claim before submitting it to a payer or a claim clearinghouse. This involves checking for appropriate codes, conflicting codes, and basic claim information such as age, gender, and location. By scrubbing a claim, healthcare providers can ensure faster payments, reduce denials, and minimize audits.

The AAPC claim scrubbing tools check claim information for correct codes, including valid codes and non-expired codes. It also checks for code conflicts against NCCI (National Correct Coding Initiative) edits, gender edits, age edits, unit edits, and medical necessity for appropriate procedures for specified diagnoses.

While most claims are straightforward and do not require a thorough scrub, it is still useful to do so for unusual code combinations or when using new or infrequently seen diagnosis and procedure codes. It is even recommended to scrub even common claims at least once a year to account for changes to the coding landscape such as deleted codes, changed codes, additional edits, and other updates.

Inefficient claims processing can take a big bite out of your revenue, with one study finding that it costs an average of $118 to rework a denied claim.

To reduce the rate of claims getting rejected or denied, more and more healthcare providers are investing in claims-scrubbing solutions. Keep reading to learn more about claims scrubbing, why it’s important, and some common terms you need to know.

Accurate coding is crucial for reimbursement, efficiency, and compliance. The UB-04 serves as a critical data source that contains 81 data points categorized into specific sections. Proficient coders must have a firm grasp of clinical documentation, stay up to date with coding regulations and guidelines, and identify coding discrepancies. This new real-time claim scrubber add-on for Complete Coder is designed to improve efficiency and accuracy.

The CMS 1500 form and the UB-04 form are two different types of medical claim forms used for submitting claims to insurance companies. While they serve similar purposes, they are designed for different types of healthcare providers and services.

Not to be confused with superbills, CMS-1500 forms are used by individual healthcare providers, such as physicians, therapists, and midwives, to submit claims for services provided to patients. They include standardized information about the patient, the healthcare provider, the services provided, and the charges for those services.

The UB-04 form is utilized by institutional healthcare providers like hospitals, nursing homes, and rehabilitation centers, to file claims for the services they provide to patients. This form has similar information as the CMS 1500 form but is specifically designed to cater to the unique requirements of institutional billing, such as room and board charges and medical equipment expenses.

It's easy to get confused between the two forms as they share some similarities in their purpose and structure. Moreover, some healthcare providers may use both forms, depending on the services they provide. However, it's crucial to use the correct form for each type of service to ensure that the insurance companies pay accurately and on time.

Use the UB-04 form:

Use the CMS 1500 form: