Achieve higher claim acceptance and higher reimbursements. Automation tools review claims prior to payor submission to improve reimbursement rates, support provider compliance, and reduce operating expenses.
We use Claim Inspector and Claim Scrubbing interchangeably. Our proprietary claim scrubbing technology is included as part of our medical billing bundle and can help maximize your revenue potential by reducing denials, identifying unbilled items, and shortening accounts receivable cycles.
For more than 20 years our exclusive medical billing claim scrubbing has helped our clients exceed industry benchmarking standards. We guarantee you’ll achieve a minimum of 95% first-pass clean claim acceptance rate.
Identifying partially billed procedures before claims submission results in complete payment for all services delivered. For prolonged services, suggested edits can help add significantly more revenue.
You can correct claims at the least costly point of your workflow.
You can reduce expenses and avoid delays associated with incorrect coding.
You can better comply with Medicare, Medicaid, and commercial regulations.
Create edits and customize system edits to match billing and reimbursement needs.
AdvancedMD partners with Optum and its extensive knowledge base of third-party industry edits to drive rules-based clinical editing that allows for extensive customization. Combined, these features help you receive appropriate and timely reimbursement, and gain financial insights that contribute to better business decisions. You receive a comprehensive Medicare, Medicaid, and commercial payor knowledge base.
Advanced data-driven rules give your billing staff immediate and ongoing updates to the knowledgebase along with new rules to help identify even more coding errors. We use timely updates to our cloud platform to ensure your practice is scrubbing claims using the latest regulatory rules. Our flexible claim scrubbing technology makes it extremely easy to upload new and customized rules.
Medicaid experts at Optum and AdvancedMD research and rapidly build the appropriate rules into our proprietary claim scrubbing technology for higher claims confidence and acceptance.
Correct Coding Initiative (CCI)
Health Insurance Portability and Accountability Act (HIPAA)
Local Coverage Determination (LCD)
Medicare Physician Fee Schedule Database (MPFSDB)
AMA Guidelines & Consulting
CPT® Assistant
CMS Program Memoranda
Local Medical Review Policy
Physician Specialty Panel
Medical Societies:
Claims scrubbing and claims inspection within our practice management and billing system is where each edit is individually controlled. You prepare your claims and then run a single batch process within AdvancedMD with no additional steps. Your billing staff enjoys a very smooth process to submit claims through our clearinghouse within your normal workflow.
In our standard reporting package, billing staff enjoys flexible reporting to view counts of claims and claim lines, display product customizations and audit logs, and schedule reports to run daily, weekly, or monthly.
NOTE: CPT is a registered trademark of the American Medical Association.
NOTE: Portions of content on this page used from Optum.