Final answer:
Claim scrubbers are healthcare tools that edit medical claims for errors like incorrect patient/provider information, coding errors, duplicate billing, date discrepancies, eligibility issues, and missing information, ensuring accurate reimbursement.
Step-by-step explanation:
Claim scrubbers are tools used in the healthcare industry to review and edit medical claims before submission to insurance payers. The common edits identified by claim scrubbers ensure that claims are accurate and complete, and typically include checking for errors such as:
- Incorrect patient information (e.g., name, date of birth, insurance ID).
- Incorrect provider information (e.g., National Provider Identifier).
- Coding errors (e.g., incorrect procedure or diagnosis codes).
- Duplicate billing (submitting the same service more than once).
- Date discrepancies (dates of service not matching, or services dated before policy coverage).
- Eligibility issues (verifying that the patient is eligible for the services billed).
- Missing information (e.g., missing modifiers or required documentation).
These edits help in reducing claim rejections and denials, thus ensuring timely and accurate reimbursement for medical services provided.
Claim scrubbers can also flag issues with the organization, tone, or flow of ideas within the documentation of the claim, similar to peer reviewers editing academic work.