Why this step decides whether the claim gets paid
Billing failures usually originate upstream of the payer. A claim built on incomplete documentation, an unsupported code pairing, or a missing modifier is rejected or denied for reasons that were visible before submission.
Medical Billing and Coding capabilities
Charge entry and capture
Encounters reconciled against the schedule so services performed are not left uncharged, with charges entered against the correct rendering and billing provider.
CPT, HCPCS, and ICD-10-CM coding
Procedures coded in CPT and HCPCS Level II, diagnoses in ICD-10-CM, with code selection supported by what the clinical documentation actually states.
Modifier application
Modifiers applied where the circumstances of the service require them, including distinct procedural service and bilateral or multiple-procedure situations.
Claim scrubbing before submission
Claims validated against payer-specific edits and National Correct Coding Initiative procedure-to-procedure edits so predictable rejections are corrected pre-submission.
Electronic claim submission
Professional claims submitted electronically using the HIPAA X12 837P transaction through your clearinghouse, with rejection reports worked rather than filed.
Payment posting and reconciliation
Electronic remittance advice (X12 835) posted against expected reimbursement, with variances identified rather than written off silently.
Our medical billing and coding process
Receive documentation
Encounter notes and superbills are received from your EHR or uploaded to a secure channel.
Code the encounter
Procedures and diagnoses are coded from the documentation, with clarification requested where the note does not support a code.
Enter charges
Charges are entered against the correct provider, place of service, and date of service.
Scrub the claim
Claims are validated against payer edits and coding edits before they leave the practice.
Submit electronically
Claims are transmitted through the clearinghouse and acknowledgement and rejection reports are reviewed.
Post payments
Remittances are posted, patient responsibility is transferred, and underpayments are flagged for follow-up.
Medical Billing and Coding questions answered
Coding is the translation of clinical documentation into standardized codes: CPT and HCPCS Level II for procedures and services, ICD-10-CM for diagnoses. Billing is the process of building those codes into a claim, submitting it to the payer, and pursuing payment through remittance, appeal, and patient balance. Coding determines what is claimed; billing determines whether it gets paid.
Claim scrubbing is validating a claim against known payer and coding edits before submission. It catches issues such as invalid code combinations, missing modifiers, incorrect place-of-service values, and demographic mismatches. Correcting these before submission avoids a rejection cycle that would otherwise add days to the payment timeline.
The National Correct Coding Initiative is a CMS program defining code pairs that should not normally be billed together, along with medically unlikely edits limiting units per service. Claims that violate these edits without an appropriate modifier are denied. Scrubbing against NCCI edits before submission prevents that outcome.
X12 837 is the HIPAA-standard electronic format for submitting healthcare claims. The 837P variant carries professional claims. Claims are transmitted in this format through a clearinghouse to the payer, replacing paper submission for most payers.
The provider remains responsible for the accuracy of claims submitted under their NPI, which is why coding must be supported by the clinical documentation rather than selected to maximize reimbursement. Our coders work from the documentation and query the provider where a note does not support the service being considered.
Prompt charge entry shortens the time to payment and keeps the practice within timely filing limits, which vary by payer and can be as short as 90 days from the date of service for some commercial plans. Delays in charge entry consume filing time that cannot be recovered.