Claim Scrubber

In medical billing, there are hundreds of billing codes, and thousands of coding rules. It is nearly impossible to remember them all! Iridium Suite has a built-in automatic claim scrubber that checks your codes against billing rules and gives you instantaneous feedback, helping your coders bill accurately the first time!

The system proactively audits your charge capture as you bill, providing you with warnings and information about violations of common billing rules before you post the charges.

By auditing your charge capture as you bill, you are able to anticipate and avoid denials before they ever happen, avoiding the need to re-bill, saving time and improving cash flow.

There are many facets to the Iridium Suite Claim Scrubber. Some important features of the Claim Scrubber are that it can help prevent mistakes like double entry, it can auto-generate new charges, and the Claim Scrubber can keep track of authorizations on patient accounts. Our Scrubber is so advanced, it can also replace codes and split codes for you when necessary.

Iridium Suite’s Claim Scrubber can be configured on a per payer basis, checking for rule violations that pertain to one insurer but not another. There is no need to tax yourself trying to memorize specific payer rules!

Claim Scrubber Components

CCI Edit Rules
CCI Edit Rules were developed by CMS to prevent incorrect coding. There are thousands of rules and it would be impossible to remember all of them. Iridium Suite has solved this problem by including CCI Edit Rules in the claim scrubber. If you enter a charge that is in conflict with a CCI Edit Rule, you are immediately notified with a warning indicator and a detailed description of the conflict.
Custom Claim Scrubbing Rules
The claim scrubber can be customized with rules which target billing violations that might be specific to a region, payer or even your practice.
Replacement Charges and Custom Splitting Rules
Oftentimes particular payers require that you bill treatments using codes that are different from the codes you would normally use for the majority of your insurers. There is no need to remember these coding exceptions. Iridium Suite remembers for you, substituting the correct code in these instances!
When required for successful reimbursement, the Iridium Suite claim scrubber can also replace one billing code with another prior to billing the charge to your insurer. For example, the claim scrubber will replace the currently unaccepted consult code with an office visit code for proper Medicare reimbursement.
Our claim scrubber will also automatically split charges for you when necessary. This is very useful in the cases where an insurer requires that certain charges are billed separately, as two different codes rather than as one combined code. In radiation oncology, the need for splitting occurs with the Medicare requirement that no more than 8 treatment devices be billed via a single code. Iridium Suite will bill up to 8 devices under a single code and will create a separate code to bill your remaining treatment devices.
Authorization Scrubber
Authorizations and their specific visit or treatment limitations can be entered into Iridium Suite. The system does not simply store the information, it will audit charges captured against the authorizations in the system. During charge capture, the system notifies the user if authorizations are expired or missing.
Auto-Generate Charges
Certain specialties, like Radiation Oncology, can bill for ongoing treatment charges such as those for weekly treatment management. These charges are often forgotten during the billing process. Iridium Suite automates the creation of these charges for you, capturing potentially overlooked revenue.