Medical Billing Claim Scrubbing For Private Practice | AdvancedMD

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Claims management software designed to make you successful as a small practice.

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.

Increase your revenue potential without adding staff or workload

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.

Claim scrubbing automation improves productivity, drives meaningful results.

Know the status prior to submission.

You can correct claims at the least costly point of your workflow.

Reduce administrative overhead

You can reduce expenses and avoid delays associated with incorrect coding.

Improve regulatory adherence.

You can better comply with Medicare, Medicaid, and commercial regulations.

Create personalized workflow.

Create edits and customize system edits to match billing and reimbursement needs.

Leverage our powerful knowledgebase & editing capabilities.

AdvancedMD partners with Optum and its extensive knowledgebase 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 knowledgebase.

  • 119 million government and third-party industry edits
  • Sourced at the code-relationship level
  • Supported by disclosure statements

Knowledgebase is maintained by a diverse team of medical & clinical coding experts.

  • 140+ clinicians, developers and engineers who support existing and new content development
  • Broad range of medical directors, specialty panels, RNs, LPNs, RHITs, RHIAs, CPCs, CCS-P, and legal experts

Claims Scrubbing

Regulatory updates are continuously aligned within the software.

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.

woman wearing yellow sweater on the train

Keep abreast of state-level Medicaid 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:

  • American College of Radiology
  • American College of Surgeons
  • American Physical Therapy Association
  • American College of Cardiology
  • American Academy of Orthopedic Surgeons
  • American College of Obstetrics and Gynecology
  • American Society of Therapeutic
  • Radiologic Oncologists
  • Society of Interventional Radiologists

Seamless workflow with flexible reporting insights.

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.

Claim Scrubbing

NOTE: CPT is a registered trademark of the American Medical Association.
NOTE: Portions of content on this page used from Optum.

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