In revenue cycle management, certain metrics are so widely used, they’re rarely questioned. But just because a number looks good doesn’t mean it tells the full story—or leads to better financial health. One of the most commonly accepted metrics in the industry may be giving practices a false sense of security.
Many practices report high clean claim rates—so why are revenue delays and rework still so common?
The culprit may be a widespread misperception about what “clean” really means—and how well today’s scrubbers are performing in reality.
When Scrubbing Falls Short
The vast majority of practices rely on claim scrubbers as a first line of defense against denials and lost revenue. On paper, these tools promise higher clean claim rates and smoother reimbursement. But the reality is that most commonly used scrubbers fall short of delivering true “clean” claims—leaving teams to chase down rejections, manually fix claims, and watch days in AR creep upward, even while reporting high clean claim rates.
Findings from Encoda’s nationwide market report help highlight the disconnect:
- 40% of practices use a clearinghouse-based scrubber
- 37% rely on a scrubber embedded in their practice management system
- 12% use a third-party scrubber
- 11% do not use a scrubber at all
That means nearly 90% of practices are using some form of scrubbing technology—yet only 31% of practice leaders believe they have an accurate view of their claims and denials process.
That’s not just a data point—it’s a red flag. And it has real downstream implications for cash flow, staff productivity, and overall financial health.
The Clean Claim Disconnect
Part of the problem lies in how “clean claim” is defined.
In most systems, a clean claim simply means one that’s accepted by the payer for adjudication—not necessarily one that’s paid on first submission. That distinction matters, because acceptance does not equal success.
Because they’re not evaluating claims in the same way the payer will, clearinghouse and practice management system scrubbers can mark claims as “clean” yet still not prevent them from being:
- Denied at the service line level
- Returned due to missing or inconsistent data
- Paid incorrectly due to outdated or mismatched payer rules
This creates a false sense of confidence—and may help explain why so many practices report high clean claim rates while still struggling with revenue performance. Rising days in AR, delayed payment posting, and overloaded billing teams are all signs that scrubbing tools may be missing the mark.
A Critical Step—Done Ineffectively
Encoda’s market report also found that 63% of practices identify claim submission as a critical part of the reimbursement process. That makes scrubber performance at this step especially important. If claims are submitted with errors or omissions—despite being labeled as “clean”—denials and underpayments are almost guaranteed.
This becomes even more problematic for:
- Complex specialties that require nuanced claim logic
- Practices facing frequent payer policy updates
- High-volume environments where manual fixes aren’t scalable
Despite these pressures, most practice management system and clearinghouse scrubbers rely on static rules that don’t evolve with payers, don’t reflect specialty-specific nuances, and don’t learn from past denials. That means billing teams are left to bridge the gap—often by reviewing and reworking claims that never should’ve been submitted in their original form.
Shifting the Focus: From “Accepted” to “Paid”
There is a better path forward. The most efficient and financially healthy practices are reframing their clean claim strategies around outcomes—not just acceptance rates.
In this model, a truly clean claim is one that gets paid on first submission without human intervention. When performance is measured by this outcome, the improvements ripple across the revenue cycle:
- Fewer touches per claim (with most requiring no touches at all)
- Faster payment posting
- Lower days in AR
- More capacity for billing teams to focus on complex or high-value issues
Rather than relying on passive rules engines that flag issues after the fact, outcome-based scrubbing prioritizes prevention—keeping claims clean in ways that actually lead to reimbursement.
Explore the Full Clean Claim Conversation
Encoda’s new ebook, The Clean Claim Myth, dives deeper into this critical disconnect—offering a framework to help practices evaluate where their scrubbers fall short and how to build a scrubbing strategy that aligns with financial outcomes.
If your practice is reporting high clean claim rates but still feeling pressure in payment posting, follow-up workload, or cash flow, it’s time to take a closer look at what your scrubber is actually delivering.
Download the ebook to see what outcome-driven, intelligent scrubbing really looks like—and how it’s helping practices reclaim lost revenue and rebuild confidence in their claims process.
