Revenue Integrity & Recovery

Payers don’t always pay what they owe. Our revenue integrity team audits collections against your contracts, identifies underpayments and leakage, and aggressively recovers the revenue you’ve already earned.

We compare every posted payment against your actual contracted fee schedule — not the amount a payer decided to send — and flag any shortfall for recoupment. Zero-balance accounts get a second look too, since a claim marked “paid in full” is exactly where underpayments hide in plain sight, and we pursue those variances with the same documentation-backed appeals we use on outright denials.

Underpayments almost never come with a note explaining themselves — a payer simply remits less than the contract calls for, and unless someone is checking every payment against the fee schedule line by line, it looks like a normal, if slightly lower, reimbursement. That’s the gap revenue integrity exists to close: routine, systematic comparison of paid versus owed, not just a reaction when something looks obviously wrong.

This service is most valuable for practices with negotiated payer contracts complex enough that verifying every payment by hand isn’t realistic — multiple fee schedules, tiered rates, or contract terms that changed at some point without every downstream process being updated to match.

If you’ve never systematically checked whether payers are actually paying your contracted rate — as opposed to just checking whether a claim paid at all — there’s a very good chance some percentage of your payments are quietly below what you’re owed.

Every posted payment gets checked against your actual contract terms as a matter of routine, not as a special project — so a systematic underpayment gets caught within weeks of starting, not discovered years later during an unrelated contract renegotiation.

Revenue integrity is the safety net behind everything else — even a well-run claims management process can’t catch a payer simply remitting less than the contract requires, because the claim itself was correct. That’s specifically what this service is built to find.

We treat the claim paid and the claim paid correctly as two different standards, and we only consider our job done when the second one is true.