Round 4 — Running the Operation
Module 5: Using Technology to Reduce Rework
When your revenue cycle can't afford to stop.
Every denied claim that comes back to be fixed and resubmitted is rework — time spent doing something a second time that should have been right the first time. Rework slows down payment, eats staff hours, and quietly inflates the cost of running the revenue cycle.
The good news is that two specific categories of technology exist almost entirely to prevent this from happening: tools that catch claim errors before submission, and tools that catch patient information errors before they cause downstream problems.
Payers run sophisticated automated edits on every claim that arrives at their door, checking for errors before a human ever looks at it. A practice can do the same thing on its own side of the transaction — checking a claim for problems before it ever reaches the payer, instead of waiting for a denial to come back.
- Claim goes out with an error
- Payer's system catches the problem
- Claim is denied and returned
- Staff investigates and corrects it
- Resubmission adds days or weeks to payment
- Claim is checked before it's sent
- Errors are flagged immediately
- Staff corrects it before transmission
- A clean claim goes out the first time
- Payment arrives faster, with less rework
A claims scrubber is software that identifies problems with a claim before it's transmitted to the payer. This functionality can sit at the point of coding and charge submission, and again as the claim is prepared for transmission — often as a built-in function of the clearinghouse itself. RehabWorks already has this layer in place through Waystar, which edits claims before they leave the building.
Making Edits Actually Get Resolved
A scrubber only helps if the edits it generates actually get worked. A few practices make this stick:
- Route each edit to the right work area — coding edits to coding staff, registration edits to the front desk.
- Put a written protocol in place so everyone knows how a given edit type gets resolved.
- Set a target: most edits should be worked within a week of appearing, not left to age.
- Watch timely filing deadlines closely on any edit that's taking longer to resolve.
Bad addresses, outdated phone numbers, and mismatched patient information cause returned mail, denied claims, and aging receivables — problems that have nothing to do with coding accuracy and everything to do with data quality. Demographic verification tools check patient information against a database of valid addresses, either at registration or before a statement goes out, and flag or correct errors within seconds.
Some practice management systems include this functionality already; many practices end up adding an external solution to cover the gap. Either way, the earlier in the process this check happens — ideally at registration, before the patient's profile is even finalized — the fewer downstream problems it causes.
Why This Matters Right Now for RehabWorks
Jill and Clita are RehabWorks' first line of defense on the demographic side — catching an address or insurance mismatch at intake is far cheaper than catching it after a claim has already been denied. And whatever scrubbing rules and edit logic currently live inside Waystar and TherapySource represent real, accumulated protection against rework.
As the EPIC migration approaches, it's worth documenting what those existing rules actually catch. Without that, there's a real risk that protections the clinic doesn't even realize it has could quietly disappear in the transition, with no one noticing until denials start climbing.
Content developed by Continuity Practice Partners, informed by the MGMA Physician Billing Process, 3rd Edition.