The Proactive Approach to Billing Claims – Practice Management Optimization!

Happy Monday, fellow leaders!

Over the past several weeks we’ve been discussing revenue cycle metrics and automation strategies practices are using to reduce risk. Today, let’s talk about something many practices already have in their systems but often underutilize: claim scrubbers.

Let me start with a few questions…

Are you still manually reviewing every coded claim before releasing it for submission? Or are you submitting claims without review and deal with a lot of denials related to coding or billing errors?

Many billing teams still check claims one by one to answer questions like:

Does this CPT require a modifier every time?

Is the procedure within a global period?

Does this payer require a different CPT code?

Are specific diagnosis codes required for medical necessity?

Does this CPT require authorization?


These checks are important—but relying on manual review slows teams down and increases the risk of missed issues.

Most Practice Management systems, including platforms like AdvancedMD, athenaOne, and Nextech, include claim scrubbers designed to catch common billing errors before submission.

When properly configured, scrubbers can flag:
• Missing modifiers
• Invalid code combinations
• Diagnosis-to-procedure mismatches
• Global surgery conflicts
• Payer-specific billing requirements

The challenge? Many practices are running these tools on default settings, which means the real denial drivers are still slipping through.

At Healthcare-IM, we help practices optimize these rules by aligning scrubbers with:
• Payer-specific billing requirements
• Modifier logic
• Global period edits
• Medical necessity checks

When your Practice Management system is optimized, claims go out cleaner, billing teams spend less time manually reviewing every detail, and avoidable denials decrease.

The question isn’t always whether you need more staff or new tools.
Sometimes the opportunity is simply optimizing the systems you already have!