Claims Scrubbing: Reduce Denials and Maximize Revenue in 2026
By: Nextech | February 24th, 2026
Even successful medical practices deal with frustration when it comes to cash flow. The longer your practice has to wait between performing a service and getting paid, the more intense the crunch.
Claims scrubbing shortens the revenue cycle and keeps cash flowing smoothly by improving your practice’s clean claims rate.
What Does a Claims Scrubber Do?
A claims scrubber flags errors, inaccuracies, and compliance issues before a medical claim is submitted to the payer. Proactively finding and fixing these issues on the front end reduces denials and leads to faster payment.
Why You Need Claims Scrubbing
- About 10% of claims are denied across all payers and specialties. More than a third of those denials do not stem from the actual service; they stem from administrative errors.
- When a claim is denied for errors, you have the option to correct it and resubmit it. But fewer than half of denied claims are ever resubmitted. Practices often lack the time and personnel to deal with reworks and appeals.
- The cost to resubmit a claim is around $25. For a practice submitting 10,000 claims a year, a 10% denial rate means $25,000 in rework costs alone.
- Claims scrubbing eliminates denials based on clerical mistakes. That saves you the cost of reworking denied claims and can shorten your revenue cycle from as long as six months to as little as two weeks.
Nextech’s Revenue Cycle Management solution helps you navigate the complexity of medical billing to collect the money you’ve earned. Request a demo.
The Claims Scrubbing Process
In claims scrubbing, medical billing software reviews completed claims for accuracy before they’re submitted for payment. Specialty-specific platforms that seamlessly integrate EHR and practice management software make it easy to collect and analyze the right data from each patient encounter.
The claims scrubbing tool makes sure the claim includes correct, up-to-date coding. The claims scrubber verifies that all the fields on the form are filled in and all the appropriate authorizations and consent forms are attached.
When using an intelligent, connected solution, the patient’s insurance information, medical information, and signed forms can be accessed quickly and conveniently. Configurable edits can be applied as needed before sending the claim off to a medical billing clearinghouse for additional review.
Finally, clean claims are securely forwarded to the insurance payer.
How Claims Scrubbing Can Reduce Denial Rates
|
Denial Reason |
Possible Claims Scrubbing Solution |
|
Missing or incorrect information (e.g., name, date of birth, insurance ID) |
Automated data verification that pulls information from the patient’s chart and documents on file. |
|
Missing prior authorization |
Automated prior authorization tracking customized to the payer and the plan. Authorization status can be viewed by both clinical and administrative staff, and authorization is confirmed before the claim is submitted. |
|
Coding errors, particularly E/M codes |
Automated code verification that checks codes against the latest updates. Claims scrubber checks codes against the patient chart to ensure the appropriate code was chosen, and against payer preferences for codes, modifiers, and bundling. |
|
Services not covered by patient’s insurance plan |
Integrated system makes it easy to look up coverage limitations before services are performed. Services not covered can be billed to the patient as self-pay, skipping the claims process altogether. |
|
Duplicate claims |
Automated tracking of previously submitted claims that flags duplicates and checks submission dates against the filing window. |
|
Missing or incorrect modifiers |
Claims scrubber configured with payer modifier rules will flag missing or incompatible modifiers and detect unbundling errors. |
|
Incorrect coding within the global period |
Claims scrubber draws data from the integrated EHR/practice management system to detect recent procedures and their global periods, and to check that services are coded and bundled appropriately. |
|
Cosmetic procedures billed as reconstructive |
Automatic flagging of CPT codes that overlap between cosmetic and reconstructive uses, with suggestions to include additional documentation, use a different code, or confirm preauthorization. |
|
Wrong payer filing |
Real-time eligibility verification that identifies which payer is primary and which is secondary and flags potential conflicts. |
Nextech’s intelligent system connects clinical and practice administration tools for complete documentation and seamless workflows. Request a demo.
How Claims Scrubbing Improves the RCM Process
Revenue cycle management, or RCM, manages the lag time between when your practice provides a service and when you’re paid for it. Denied claims slow down the RCM process, choking cash flow.
Clean claims are often processed and paid within weeks, while denied claims can take months to resolve.
In a healthy flow, you deliver a service, file a claim, the claim is reviewed, and payment is sent.
When a claim is denied, it usually comes with an appeal window of three to six months. You need to identify the reason for the denial, correct the errors, and resubmit for a second review. Payment might come as much as half a year after the initial service was provided.
How to Start With Claims Scrubbing
Your practice can begin scrubbing claims and collecting payments faster in just four steps: choose a partner, decide on benchmarks, implement the process, and monitor results.
1. Choose a Claims Scrubbing Partner
The first question is whether you will handle claims scrubbing in-house or outsource it to a third party. Choose a solution tailored to your specialty-specific needs to avoid common denial triggers like improper coding.
If you’re outsourcing, that means finding a vendor that specializes in your area of medicine. If you’re keeping it in-house, that means equipping your billing team with powerful tools that automate most or all of the claims scrubbing process.
Nextech has specialty-specific platforms for dermatology, ophthalmology, and plastic surgery that automate claims scrubbing as a seamless process.
2. Set Claims Scrubbing Benchmarks
To make sure your investment in claims scrubbing is delivering returns, set benchmarks to track on a regular basis.
Good metrics to track include first-pass acceptance rate, denial rate, average number of days in A/R, and cost per claim for resubmittal.
3. Implement a Claims Scrubbing Process
You want your claims scrubbing process to operate as efficiently as possible, so you don’t lose your savings to wasted staff time.
Set up your practice’s software to either integrate with your third-party partner for secure data transfers or to automate claims scrubbing in your billing process.
If you’re outsourcing, be careful to choose a partner with rigorous data safety and privacy measures.
If you’re automating claims scrubbing, configure your tools to scan for common denial triggers and to recognize the preferences of specific payers.
4. Monitor The Results of Your Claims Scrubbing Program
Regularly check the benchmarks you set to see if your claims scrubbing process is working.
Whether you are using software or a partner, you should be able to routinely access easy-to-read dashboards and reports to see how your process is performing.
Collect the Money You’ve Earned Faster and Easier With Nextech
Nextech’s intelligent, intuitive tools streamline coding, billing, and collections for busy ophthalmology, dermatology, and plastic surgery practices.
Automated tools reduce errors and free up staff time for more valuable tasks that help your practice grow. Our scalable solutions are easy to implement and simple to use, with the average team taking less than a week to onboard.
Request a demo today and see how Nextech can help you collect the money you’ve earned and scale your practice to do more.
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