Charge Entry and Claim Scrubbing
Claims checked against payer-specific rules before they leave, not after they bounce.
Charge entry is where the clinical note becomes a claim. Scrubbing is the check that happens between that translation and submission. Together they decide your first-pass clean claim rate, which is the number that determines how much rework the rest of your revenue cycle has to absorb.
A practice submitting at 85% clean is reworking roughly one claim in seven. Every one of those costs staff time, delays payment by weeks, and moves closer to a filing deadline. A practice at 97% is doing almost none of that work, and the difference is mostly about what gets caught before the claim leaves.
We enter charges daily from the documentation and run every claim through payer-specific edits before submission, so errors surface in seconds rather than in a remittance three weeks later.
The problem
Where this usually goes wrong
Charges entered days late
Charge lag pushes every downstream date back with it. A claim entered a week after the visit is a week later getting paid, and a week closer to a filing deadline before anyone has touched it.
Generic scrubbing that misses payer rules
Most built-in scrubbers check that the fields are filled in. They do not check whether this particular payer accepts this modifier on this code, which is where a large share of rejections actually come from.
Rejections treated like denials
A rejection never entered adjudication, so it is not on the payer’s books and will not appear in a denial report. If nobody watches the clearinghouse queue, rejected claims sit invisible until timely filing runs out.
What is included
- Daily charge entry from the clinical documentation
- CPT, ICD-10 and HCPCS validated against the note before the claim is built
- NCCI bundling and mutually exclusive edits applied
- Modifier logic checked against the specific payer’s policy
- Medical necessity edits, so the diagnosis actually supports the procedure
- Demographic, plan and provider identifier validation
- Clearinghouse rejections worked the same day they appear
- First-pass clean claim rate reported monthly, by payer
How it runs
Our process
- 1
Charges in daily
Charges are entered every business day from the documentation, not batched to the end of the week. Charge lag is one of the few revenue cycle problems that costs nothing to fix.
- 2
Validate against the note
The codes are checked against what the documentation actually supports, which catches both undercoding and codes the note will not defend in an audit.
- 3
Scrub against payer rules
Every claim runs through general edits and then payer-specific ones. The same code pair can be clean for one carrier and an automatic rejection for another.
- 4
Fix before submission
Anything the scrubber flags is corrected before the claim leaves. Where the fix needs a clinical answer we query the provider rather than guessing at a code.
- 5
Work the rejection queue
Clearinghouse rejections are worked the same day. Because a rejection is not a denial, this queue is the one most likely to go unwatched in a busy practice.
Scrubbing before submission compared with reworking afterwards
| Metric | Billing in house | With AsesorMD |
|---|---|---|
| Charge lag | Several days to a week | Same or next business day |
| Edits applied | Generic completeness checks | NCCI plus payer-specific policy |
| First-pass clean rate | Typically 80 to 87% | Target 97% and above |
| Rejections | Sit in a queue nobody owns | Worked the same day |
| When errors surface | In the remittance, weeks later | Before the claim is sent |
Questions we get asked
What is the difference between a rejection and a denial?
A rejection is stopped before adjudication, usually at the clearinghouse or the payer’s front door, for a format or data problem. A denial went through adjudication and was refused. Rejections are cheaper to fix but easier to lose, because they never appear in a denial report.
What clean claim rate should we expect?
A well-run practice submits at 97% or better on first pass. Practices that have never measured it are often in the low to mid eighties, and that gap is where most of the avoidable rework lives.
Do you use our existing scrubber or your own?
Both. We use whatever is built into your PM and clearinghouse, then layer our own payer-specific rules on top. The built-in checks catch format problems; the payer rules catch the ones that actually get claims rejected.
What happens when the documentation does not support the code?
We query the provider. We do not upcode to make a claim payable and we do not quietly downcode to make it safe, because both are the wrong answer and one of them is fraud.
How quickly are charges entered?
Same or next business day from the documentation being available. If the note is not signed, the charge waits on the note rather than going out unsupported.
Can we keep coding in house and use you only for scrubbing?
Yes. Some practices have a coder they trust and just want the payer-rule layer and the rejection queue covered.
See what your practice is leaving on the table.
We look at 90 days of your claims data and tell you what is recoverable. No cost, no obligation, BAA signed before anything changes hands.
- Recoverable dollars in your aged A/R, as a number
- Denials grouped by root cause, ranked by value
- A written summary you keep either way
Prefer to talk? (301) 786-0552
Or email info@asesormd.com