Patient care sits at the heart of healthcare. Delivering that care takes place alongside a complex billing system where clinical documentation must meet strict payer and regulatory demands. Claim scrubbing simplifies the path from clinical documentation to compliant claims, especially when automated scrubbing software is combined with human expertise.
The bottom line is that 80% of medical bills contain mistakes, often due to coding errors and incomplete documentation that don't align with payer requirements. Unfortunately, the compounding cost of this can fall back on healthcare providers or patients themselves.
To guide you in refining your billing strategy, we are providing insights on what claim scrubbing involves, the benefits of automation, and how to find tools that match your practice's unique needs.
What is Claim Scrubbing?
Claim scrubbing is an automated process through which medical insurance claims are scanned and checked to ensure accuracy. These claims should be complete, free from errors, and contain the correct codes. Accurate coding means that each documented condition and treatment must map to the expected insurance code and meet payer-specific requirements.
If medical claims have missing or incorrect information, the billing process stalls. To avoid this, claim reviews can be performed through automated systems called claim scrubbers to check claims against coding standards and payer rules.
Manual Review vs Claim Scrubbing Process
Where manual claim review is labor-intensive and prone to human oversight, claim scrubbing is swift, consistent, and designed to catch errors before they become costly delays.
Manual claim review relies on billing or coding staff reviewing claims one at a time and checking for missing information based on experience and reference materials. The accuracy of the review depends on staff availability, training, and workload, which increases the risk of missed errors as volume grows.
Claim scrubbing reviews every claim systematically using predefined coding standards and payer rules. Claims are checked automatically for common issues before submission, and only complex cases that require specialist criteria are flagged for human review.
| Manual Review | Claim Scrubbing |
| Relies on staff reviewing claims line by line, which is time-consuming and repetitive | Reviews claims automatically at scale, with no added manual effort |
| Varies by individual experience, workload, and time constraints | Applies the same rules consistently to every claim |
| Higher risk of missed errors, especially under volume or staffing pressure | Identifies common and complex errors before claims are submitted |
| Slows claim submission and can create bottlenecks | Processes claims quickly without delaying submission |
| Difficult to keep up with frequent payer and regulatory changes | Updates rules centrally to reflect current payer requirements |
| Pulls billers and coders away from higher-value work to carry out routine checks | Allows staff to focus only on true exceptions and complex cases |
| Requires more staff as claim volume grows | Scales easily without increasing headcount |
Benefits of Automation in Claim Scrubbing
While the claim scrubbing process makes work easier for medical billing teams, automation further alleviates the load. Automation allows for errors to be corrected without human intervention from your team. By working in the background, physicians and RCM teams can focus on improving services rather than getting stuck in administrative challenges. This is how it could benefit your organization:
Cleaner Claims
Claim denials are a headache. But with automated claim scrubbing, you can catch and correct errors without intervention before the claim is submitted. With peace of mind that your claims are clean when you submit them, you can eliminate unnecessary frustration and keep your revenue cycle moving forward. Most importantly, cleaner claims mean fewer preventable denials and less downstream rework.
Faster Payments
When you have less back-and-forth with payers, the process is smoother. Instead of spending excess time and resources on trying to fix inaccurate claims, you wrap up quickly and receive payments faster. Industry benchmarks show that organizations with high clean claim rates experience faster reimbursement and fewer payment delays, helping providers plan more confidently and reduce pressure on accounts receivable teams.
Reduced Administrative Burden
Automated claim scrubbers eliminate repetitive manual checks, meaning that instead of reviewing every claim, staff focus only on the claims that truly need attention. The accumulative benefit is reduced cognitive load, limiting burnout in roles that already face staffing challenges. Over time, more stable billing operations and reduced delays support healthier staff-to-patient relationships.
Patient Satisfaction
When your staff have time and resources, they are able to provide a better service to patients. Automated claim scrubbing also reduces confusion and errors relating to payments, meaning that patients have clarity and peace of mind that the bill they or their insurers receive is right the first time. Given that strong communication is a core indicator of patient satisfaction (according to the National Library of Medicine), accurate billing is important for bolstering organizational trust.
Healthier Resource Management
Unlike manual claim review or claim scrubbers that require a claim by claim review, which requires extra staff as the organization grows, automated claim scrubbing is more easily scalable. By applying the same rules regardless of volume, scrubber technology allows organizations to expand services and absorb seasonal volume changes without the operational strain of additional staffing costs.
Better Compliance
Healthcare regulations don't stand still. As coding guidelines evolve and payer requirements shift, compliance standards grow more complex with each passing year. This is reflected in expectations relating to medical claims management. Claim scrubbing not only lowers denial rates but also helps providers reduce audit exposure and protect revenue from recoupments tied to avoidable billing errors.
What to Look for in Claim Scrubbing Software
With the demand for cleaner claims management so high, implementing claim scrubbing software is a sensible choice. With so many solutions on the market, however, you may find yourself overwhelmed by the selection. Here are recommendations for what to consider in your research.
1. Accuracy
Inaccurate claims can be damaging for patient care and your healthcare organization's credibility. Accuracy goes beyond catching basic errors, so choose software that stays up to date. Effective claim scrubbing software should validate claims against current coding standards and payer rules while taking specialty-specific requirements into consideration.
2. Workflow Integration
Claim scrubbing works best when it fits naturally into your existing workflow. This means integrating with your electronic health record (EHR) and practice management system. Without integration, you could experience bottlenecks that slow down your users and undermine the value of automation.
3. Transparency
Look for visibility into editing, update routines, and change management processes. When you have clear access to information, you can be transparent with stakeholders and build trust, especially when questions arise from providers or leadership. This could, in fact, help you to outperform competitors, according to a 2023 U.S. study.
4. Ease of Use
Claim scrubbing software should save you time as soon as possible. A complicated system that your team finds difficult to use will only set you back. Look for software that provides a full suite of everything you need but presents it in an easy-to-understand way or provides training to help get your staff on board.
5. Scalability
As the healthcare landscape adapts—and it will—so will your healthcare organization. If you know that you are likely to see growth or restructuring at your site, then you need to find software that will change with you and support these developments.
6. Human-centricity
Automation should support your team, not replace their judgment. The best claim scrubbing software recognizes that staff expertise still matters. Systems that surface issues clearly, allow for human review when needed, and adapt to how your team works are better than those that force rigid processes.
Aptarro ClaimStaker Reduces Claim Rejections
Claim scrubbing works best when it is consistent, current, and aligned with how your team actually operates. Aptarro's ClaimStaker supports that goal by helping your organization submit cleaner claims the first time, with fewer preventable denied claims and less downstream rework.
Our software works by combining deep billing and coding logic with frequent payer and regulatory updates, which means your team can rest assured that compliance-based errors will be caught in real-time. When your claims process runs smoothly, you see fewer delays and faster reimbursement.
ClaimStaker is the simple antidote that can keep your revenue cycle healthy. Request a demo today and see how it can help your organization.
FAQs
What is claim scrubbing in medical billing?
Claim scrubbing in medical billing is the process of reviewing claims before submission to ensure they are accurate, complete, and compliant with coding standards and payer requirements. This includes validating diagnosis and procedure codes, modifiers, patient and insurance information, and payer-specific rules.
Is claim scrubbing the same as denial management?
No. Claim scrubbing is a component of a good denial management strategy. Claim scrubbing focuses on identifying and correcting errors before a claim is submitted. Denial management occurs after a payer has already rejected or denied a claim.
Can small and mid-sized healthcare providers benefit from automated claim scrubbing?
Yes. While larger organizations often adopt automation first due to volume, small and mid-sized providers can see meaningful benefits as well, especially if they are scaling. Automated claim scrubbing helps teams work more efficiently, reduces reliance on manual checks, and applies consistent rules regardless of staff size.
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