Question

Claims editing software or scrubber analyzes claims for accurate coding and formatting before submission to payers or clearinghouses. They generate reports which tell the organization which claims are payable and which may be denied.  

Research two providers of this software on the internet, examine and compare their features in your post. Which features do you think are the most and the least useful for a healthcare provider based on your analysis?

Answer 1

Claim editing software or scrubbers are -

To receive payment after providing a patient with medical care, the insurance company needs to receive a claim for the care.  Claims scrubbing is the part of the process that ensures there are no mistakes in the claim that would lead the insurance company to deny it.

Softwares providing claim scrubbing-

1. Advanced MD

2. Intergy

3. Nextgen

Details of software-

1. AdvancedMD

AdvancedMD is a cloud-based software suite that offers medical billing, electronic health records (EHR), and practice management capabilities. Its billing features include claims scrubbing, billing analytics and reporting, compliance tracking, mobile payments, and remittance advice. The software is suitable for medical practices of all sizes.

Features-

• It’s a centralized platform that allows physicians to manage the entire claims process using a single tool.
• It has an integrated clearinghouse that eliminates the need for practitioners to upload claims and download remittances.
• The billing feature can track existing as well as past payment details.

Least used features- A few users said that the billing application can be slow at times, and reported screen freezes requiring them to log back in.

2. Intergy

Intergy is a fully integrated medical billing, EHR, and practice management solution. Its billing features include claims scrubbing, compliance tracking, and remittance advice. The software is suitable for medical practices of all sizes and can be installed on-premise or used in the cloud.

Features-

• It provides a built-in claims validation engine that identifies and corrects errors in claims before submission to insurance agencies, reducing chances of rejection.
• It allows practitioners to leverage data analytics to identify and analyze the top reasons for claims rejections.
• Its electronic claims submission capability enables practices to submit multiple claims with a single click.
• Its user management feature allows practices to add, remove, or manage user permissions for each billing staff member.
• The billing application is easy to set up, and its features are intuitive.

Least used features-

Some users said that they didn’t receive software support and training before going live. Instead, they were asked to watch training videos, which couldn’t answer all of their queries.

3. NextGen

NextGen is a fully integrated medical billing, EHR, and practice management solution. Its billing features include claims scrubbing, compliance tracking, remittance advice, and quote and estimate management. The solution is suitable for medical practices of all sizes and can be installed on-premise or used in the cloud.

Features-

• It uses advanced claims scrubbing technology to eliminate errors in billing codes.
• It offers a predictive rules engine that reviews data entered against customizable claims rules to identify and remove manual errors.
• It automates time-consuming billing tasks, such as filing claims, generating payment, collection, and billing reports, and printing patient statements.
• It streamlines front and back-office administrative tools to offer an integrated eligibility check, claims status verification, clearinghouse, and patient portal that efficiently manages the billing process.
• The support team is quick to respond to billing issues.

Least used features-

Few users say they are unable to see the payer ID at times, so they aren’t sure if claims are being submitted to the correct insurer.