01
Identify potential payment variances
We review available payment and reimbursement data for claims where the amount received appears inconsistent with the expected reimbursement.
Paid is not always correct
Medical underpayment recovery for independent practices
A claim can be paid and still be paid incorrectly.
That is what makes underpayments easy to miss. The remit comes in, the payment gets posted, the balance closes, and everyone moves on.
But if the payer reimbursed less than expected, earned revenue may be left behind.
VeroRCM helps independent physician practices identify potential insurance underpayments, review the reason for the difference, and pursue appropriate payer follow-up when additional reimbursement may be owed.
Paid claims
Find the claims that were paid — but may not have been paid correctly
Most billing teams naturally focus on unpaid claims and denials.
Paid claims tend to receive far less attention.
Where the necessary reimbursement information is available, Vero compares what the payer allowed and paid against what the practice expected to receive.
A difference does not automatically mean the payer made an error.
It means the claim deserves another look.
For a deeper explanation, see our guide on how medical practices can identify insurance underpayments.
Causes
Why medical claims get underpaid
There are many reasons a payment may come in below expectations.
The difference may involve:
- Contracted reimbursement rates
- Incorrect contractual adjustments
- Professional and technical components
- Modifiers
- Units
- Multiple-procedure reductions
- Add-on services
- Bundling
- Place of service
- Fee-schedule differences
- Payer-specific reimbursement rules
Some payment differences are completely appropriate.
Others may represent recoverable revenue.
The important part is being able to tell the difference.
Our approach
How Vero approaches underpayment recovery
02
Validate the difference
A billing professional reviews the claim, remit, adjustments, modifiers, components, and other available information. The goal is to determine whether the variance has a legitimate explanation or deserves additional payer follow-up.
03
Prioritize recoverable claims
Not every small variance deserves the same amount of effort. We focus on claims where the potential recovery and supporting information justify additional work.
04
Pursue the payer
When there is a reasonable basis to challenge the payment, the claim moves into the appropriate payer follow-up, reconsideration, or dispute process.
05
Look for recurring patterns
One underpaid claim may be an isolated issue. Dozens of similar claims from the same payer, procedure, or reimbursement rule may point to something larger. That is where underpayment analysis becomes more valuable than simply chasing individual balances.
People and technology
Technology helps find the variance. People decide what happens next.
We do not believe software should automatically dispute every payment that differs from an expected amount.
Vero uses technology to help surface payment discrepancies and patterns across a larger volume of claims.
Experienced billing professionals review those findings before action is taken.
Technology helps us find what deserves attention. People remain responsible for the payer follow-up.
Not a denial
Underpayments are different from denials
A denial is usually easy to see because the payer did not pay the claim as expected.
An underpayment is harder to spot because money was received.
The claim may look complete even though the reimbursement deserves another review.
That is why underpayment recovery should sit alongside denial management and A/R recovery as a separate part of the revenue cycle.
Denials ask: Why didn't this claim get paid?
Underpayments ask: Did this claim get paid the right amount?
Both matter.
Patterns
Why underpayments can become a significant revenue leak
A single short payment may not seem important.
But small reimbursement differences can add up when the same issue occurs across hundreds or thousands of claims.
The biggest concern is not always one large underpayment.
It is a repeatable reimbursement issue that continues unnoticed because every affected claim is being marked as paid.
That is why we look for patterns across the payment history rather than reviewing each remit in isolation.
Start with the data
You do not have to replace your current billing company
Underpayment review can start with the billing data you already have.
Our Free Revenue Leak Audit can look at available claims, payments, denials, underpayments, and A/R to identify areas that may deserve more attention.
You do not need to switch billing companies first.
Start with the data.
Then decide whether anything needs to change.