Medical billing errors can be costly and time-consuming, leading to denied claims, delayed reimbursements, and administrative frustration. This is where claims scrubbing becomes essential. By ensuring claims are accurate and complete before submission, healthcare providers can improve cash flow, reduce denials, and enhance overall revenue cycle management.
What Is Claims Scrubbing?
Claims scrubbing is the process of reviewing medical claims for errors, inconsistencies, and missing information before they are submitted to insurance payers. It involves using automated software, manual review, or a combination of both to verify that claims meet payer-specific requirements and follow proper medical coding protocols.
The goal of claims scrubbing is to catch and correct errors before submission, ensuring claims are clean, accurate, and processed without delay.
Why Claims Scrubbing Matters
- Reduces Claim Denials
One of the leading causes of claim denials is incorrect or incomplete information. Claims scrubbing helps identify errors—such as incorrect CPT or ICD-10 codes, missing patient details, or mismatched insurance data—before submission, reducing the likelihood of denials. - Speeds Up Reimbursement
Denied claims require additional time and effort to correct and resubmit. By preventing errors upfront, claims scrubbing accelerates the approval process, ensuring healthcare providers receive payments faster. - Improves Revenue Cycle Efficiency
Clean claims mean fewer rejections and reduced administrative burdens. Practices that implement a strong claims scrubbing process spend less time on appeals and corrections, freeing up resources for patient care and operational improvements. - Ensures Compliance with Payer Requirements
Insurance payers have specific guidelines and coding requirements that must be met for claims to be accepted. Claims scrubbing helps ensure compliance with Medicare, Medicaid, and private insurance policies, reducing the risk of audits and penalties. - Enhances Data Accuracy
Accurate claims data improves reporting and analytics, allowing practices to track billing trends, identify recurring issues, and optimize financial performance.
Common Errors That Claims Scrubbing Prevents
Incorrect patient information (misspelled names, wrong date of birth, or incorrect insurance details)
Coding errors (inaccurate CPT, HCPCS, or ICD-10 codes)
Missing or incomplete provider information
Upcoding or undercoding (billing at incorrect levels of service)
Lack of medical necessity documentation
Mismatched diagnosis and procedure codes
How Claims Scrubbing Works
Automated Software Review
• Many healthcare practices use claims scrubbing software that integrates with their billing system. This software automatically scans claims for coding errors, missing data, and payer-specific requirements.Manual Verification
• While automation is powerful, a human review is often necessary for complex cases or unusual claim scenarios. Medical billers and coders may double-check high-value claims or those flagged by software.Real-Time Corrections
• Identified errors are corrected before submission, ensuring claims meet all necessary criteria.Submission to Payers
• Once scrubbed, claims are submitted electronically through clearinghouses or directly to insurers, reducing processing times and improving approval rates.
Best Practices for Effective Claims Scrubbing
Use Updated Coding Guidelines: Regularly update CPT, ICD-10, and HCPCS codes to reflect the latest industry changes.
Train Billing Staff: Ensure your team is well-versed in payer policies and common billing errors.
Implement Automation: Invest in claims scrubbing software that integrates with your electronic health records (EHR) and billing systems.
Track and Analyze Denials: Identify patterns in claim denials and adjust workflows accordingly.
Verify Patient and Insurance Information: Double-check details at the time of service to prevent issues down the line.
How Orchard Medical Management Can Help
At Orchard Medical Management, we specialize in claims scrubbing and revenue cycle optimization, ensuring your practice submits clean claims that get paid faster. Our expert team leverages technology, industry expertise, and proactive strategies to reduce denials, improve cash flow, and streamline billing operations.
Don’t let claim errors slow down your reimbursements—partner with Orchard Medical Management today to optimize your claims process.