The crucial role of Claim Scrubbing in Medical Billing?

Healthcare professionals spend most of their time learning the best ways to improve the lives of human beings, but when it comes to the billing side, they are not experts or do not have much time to deal with the administrative burden. 

Unfortunately, when healthcare professionals do not have the expertise or do not meet the criteria for accurate claim filling, they end up losing a lot of money on the table. On the other side, even if they correct the mistakes and resubmit the claim for reimbursement, it also costs an average of $118 to fix the issues and submit the claim. 

In order to reduce the claim denial rate, physicians choose to outsource the medical claim submission process to a third-party medical billing agency, making the best use of claim scrubbing software to get paid in the first place.

Keep reading if you are interested in learning about the common intricacies of claim scrubbing, its significance, major parts, benefits, common challenges, and the usage of scrubbing software to handle claim submissions. 

What is medical billing?

Medical billing is the process of generating and submitting claims to the insurance providers to get paid for the healthcare services rendered to the patients.  After careful translation of the healthcare procedures to the medical codes, healthcare providers or billing agencies dealing with the financial side follow the claim to help the doctors pay for their medical services. However, it would be sufficient to say that medical billing professionals or accurate billing plays a significant role in the financial success of healthcare practices.

What is claim Scrubbing?

It is the process of verifying the relevant information, including medical codes, to make sure there are no errors. Medical billers submit thousands of bills daily to the relevant healthcare insurance companies. In case the claims do not bring the reimbursement for the claim, the medical billers have to resubmit the claim after resolving the issues. This repetition causes revenue loss and payment delays, affecting the healthcare organization’s workflow. This is where the role of a medical scrubber comes in, a medical scrubber double-checks the claim for accurate coding and patient information.

Benefits of claim scrubbing 

It offers significant benefits like:

Pinpoint Errors

Claim scrubbing spots the errors beforehand such as incorrect information, errors in the healthcare treatments incomplete documentation. By taking the precautions, providers can ensure 1000 percent accuracy and get paid on the first round. Doing this improves the overall revenue cycle efficiency and productivity of the healthcare and billing sides.

Minimize the claim rejection rate

When submitting an accurate claim to the insurance companies, healthcare providers get paid on time in the first round. It helps to make sure that claims are complete and flawless and meet the insurance companies’ criteria. When claims meet the criteria, they are more likely to get paid at the first submission.

Make your patient feel satisfied

Claim scrubbing ensures the patient gets an accurate bill. When you ensure transparent billing, patients feel satisfied, and they are more likely to visit the clinic again. So, more patients mean more revenue.

Compliance with regulatory requirements

Claim scrubbing also plays a leading role in ensuring that claims meet compliance and regulatory requirements, including HIPAA, by ensuring that patient confidential information is secure and protected from unauthorized users.

Role of claim Scrubbing Software

Scrubbing software also plays an important role in streamlining the medical billing process These programs are designed based on dynamic algorithms and rule-based engines to analyze the reclaims and ensure they are error-free.

In addition, scrubbing software can also be integrated with the practice management and electronic health record (HER) System.

However, apart from the positive side, there are some challenges that also seem a bit difficult for the claims scrubbing software’s foresentence complexity of medical coding and regular updates in the medical billing and coding is a big challenge for the claims scrubbing software.

Moreover, there are also interoperability challenges when it comes to integrations of claim scrubbing software with existing systems.


Claim scrubbing plays an important role in revenue cycle management in order to promote compliance with standards and promote efficiency and accuracy. Scrubbing software also plays an important role in streamlining the billing process and minimizing claim rejections.  However, it will be suffice to say that claims scrubbing will be the big gun to streamline the revenue cycle management process and deliver quality patient care.


How Claims scrubbing process can be improved?

There are several ways to improve the claims-scrubbing process in the healthcare system:

  •  Integration of Robust software system
  •  Conduct regular training programs for the team
  • Collaborate with payers
  •  Regularly perform internal Audits

What is the process of cleaning the Claim?

A healthcare provider or the biller oversees the claim and resolves the issues causing denials. After the process, he submits the claim to the insurance company and follows up until the claim is accepted and the healthcare provider gets paid for the services rendered. 

Author Bio:

Writer Laura Adams is passionate about makeup and cosmetics, especially whitening goods. She began her career in the beauty sector more than eight years ago, and ever since, she has guided readers through the worlds of vaginal lightening cream cosmetics and skincare. Laura’s writings are renowned for their clarity and practical advice, which helps everyone understand beauty regimens. She likes to test out new goods and report back to her audience with her findings, always trying to provide frank and helpful advice. Laura enjoys doing beauty tutorials and trying various styles in her free time.


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