A routine claims review uncovered $557,855 in reimbursement that was never going to arrive on its own.

Payers underpay in amounts too small to notice, and too consistent to ignore.

The practice's EHR and billing platform had underpayment-reporting functionality built in — but like most systems, it only works if someone loads and maintains the fee schedule every quarter. That maintenance had quietly lapsed, and small shortfalls, a few dollars below the Medicare allowable rate on claim after claim, had been accumulating for longer than anyone realized.

None of it showed up as an obvious problem. The practice was getting paid. Claims were closing. On a monthly cash-basis view, everything looked normal.

Cash-basis books show you what arrived. Accrual books show you what was owed.

We took over this practice's bookkeeping at the beginning of the year. Like many independent practices, they had been operating on cash-basis accounting — tracking revenue as payments arrived, not as it was earned. One of the first changes we made was moving them onto accrual accounting, where revenue is recognized when it's earned — at the time of service, against the allowable rate — rather than simply when a payment lands in the bank. That single change is what made the shortfall visible in the first place.

This wasn't a failure by the billing team. It was a missing check on their work.

The practice's billing staff, like most, were focused on getting claims out the door accurately and on time — not auditing whether every one of thousands of claims paid at the correct rate. That's not a knock on their work; it's simply not the job billing teams, in-house or outsourced, are built to do on their own.

What closed the gap was an independent party reviewing the outcomes, not just the process. Once we flagged the discrepancy, the practice's own billing team took ownership of resubmitting the affected claims — we didn't replace their work, we made sure nothing was slipping past it unnoticed.

What the review turned up.

The practice's billing team is now resubmitting corrected claims, and we're tracking recovery progress with them on a weekly cadence to make sure it gets seen through to completion — not just identified and left on a shelf.

If this can happen on a well-run practice's books, it's worth checking your own.

• Underpayments like this rarely announce themselves — they hide inside numbers that otherwise look correct.
• If your books are kept on a cash basis, this exact gap is much harder to catch.
• Whether your billing is handled in-house or by a third party, an independent check is the only way to know for certain nothing is slipping through.
• Because claims can typically be reviewed retrospectively for several years, the opportunity in an unreviewed practice is often larger than a single quarter would suggest.