Comparative Study of Medical Claim Scrubber And A Rule Based System

Medical billing is a complex, dynamic, knowledge oriented process. To avoid claim rejections almost all of the leading companies with their business related to medical billing/medical claim processing provide some sort of claim scrubbing software tools. This research is a comparative study of two claim scrubbing tools developed at a USA based medical billing company. Although both the tools have same purpose of medical claim scrubbing but their implementation methodology is different. One is conventional software based on stored procedures and functions; we name it simply 'medical claim scrubber'. And other has been developed using rule based systems concepts; so we name it 'A rule based system'. This paper presents strong and weak points of both the tools. A new hybrid design has also been proposed, which combines both of them. Currently this hybrid architecture has been proposed for medical billing domain, but it can be applied to virtually any domain of real life where complex, dynamic, knowledge oriented edits are required to be implemented.