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Leak 2: Underpayments

The Silent Leak: 3-7% Paid Below Contract—Every Payer, Every Month

A payer sends $847. Your contract says $923. Your EHR posts $847. The $76 difference disappears.

At $25M revenue, that's $750K to $1.25M lost annually. High-complexity specialties: up to 11%. ANKA checks every payment against every payer contract. Identifies the variance. Recovers what you're owed. Contingency pricing — zero risk.

$76
One underpaid claim. Multiply by thousands. Your team didn't catch it. ANKA does.
Calculate Your ROI Watch It Work
ANKA underpayment detection dashboard comparing payer reimbursements against contracted rates
100%Of payments verified against contract
$100K+Median first recovery per client
0%Upfront cost or monthly fee
97%Collection success rate
30 daysAverage first recovery timeframe
The Silent Leakage Problem

3-7% of payments fall below contract (Rivet Health, MGMA). Most organizations never notice

Your billing team can't manually verify every payment against 50+ payer contracts. Payers know this. The underpayment slips through. Your EHR posts it. The variance becomes invisible.

3–5%
Of net revenue lost to underpayments annually. Silently. Every month.
$847 vs $923
One claim. $76 difference. Multiplied across thousands of claims per month.
$750K–$1.25M
Annual leakage at a $25M revenue practice. High-complexity specialties: $2.75M+.
11%
Revenue loss in pain management, anesthesia, and specialty procedures. Highest-risk segments.
Zero
Current tools that catch this. Your EHR doesn't. Your billing staff can't. Standard RCM software misses it.

The math is clear. The solution is ANKA.

How ANKA Recovers It

Execution in five steps. No meetings. No consultants. Just work

1

Maps Contracts

ANKA ingests every payer contract. Fee schedule. Modifier rules. Allowed amounts. Billing code dependencies. Everything that defines what you should be paid.

2

Compares Payments

Every incoming payment gets checked against the applicable contract. Did the payer pay the right amount for this code, this modifier, this patient status, this timeframe?

3

Identifies Variances

When contracted amount doesn't match payment, ANKA flags it. Shows you the gap. Quantifies exactly what you're owed and why the payer underpaid.

4

Assembles Documentation

ANKA pulls clinical evidence. Contract language. Fee schedule excerpts. Builds the case for recoupment without your team lifting a finger.

5

Submits & Tracks

Submission goes to payer. ANKA monitors response. Escalates if needed. Recovers the money. You see it posted. No follow-up required from your side.

Underpayment recovery connects to your other RCM work.

AI Denial Management AR Follow-Up

Zero-Risk Contingency Pricing

Nothing upfront. Nothing monthly. You pay a percentage only on what we recover. If we find nothing recoverable, you owe nothing.

Typical first finding: $100K+ in underpaid claims

Actual results from clients in your revenue range.

Proof

Numbers. Not promises

Hospital Group · 4 Locations

$1.2M in Underpayments Recovered in Year 1

Before: No formal process to catch underpayments. $82M open AR. Estimated 3-5% revenue leakage. Payers underpaying with no accountability.

After: First 90 days: $340K recovered. Year 1: $1.2M in previously unrecovered underpayments. Ongoing: All future underpayments caught automatically.

Pain Mgmt · 250+ Practitioners

98% NDC-Related Denial Reduction

Before: 72% of office visit denials traced to single payer auth requirement nobody caught. Revenue impact: $180K/month.

After: Contract requirement identified and fixed. 98% denial reduction in that category. Combined with underpayment recovery: 40% collections increase year-over-year.

Modern Healthcare (2025): Underpayment recovery is fastest-growing RCM strategy
HFMA: Average healthcare provider leaves 3-5% of net revenue on the table
Specialty practices: 8-11% revenue leakage, mostly in high-complexity codes

You can't recover what you don't check. ANKA checks it all.

Questions

Underpayment Recovery FAQ

We accept fee schedules in any format: PDFs, Excel sheets, EDI 834 files, direct payer API feeds. Our team ingests and maps them. You don't build anything. The initial contract load typically takes 2–4 weeks depending on the number of payers and complexity of your billing structure.

We verify every flagged variance against the applicable contract, modifier rules, and patient eligibility at the time of service. False positives are rare because we're comparing exact payment against written contract terms. Our clients see 97% collection success on identified variances, meaning payers agree and pay back what they owe.

First discovery: 30 days into contract mapping. First recovery: typically 30–60 days after submission, depending on payer response time. Ongoing underpayments are caught and flagged within 24 hours of payment posting. The faster you know, the faster you recover.

No. You're asking payers to honor their signed contracts. That's not aggressive—that's business. Our submission process is professional and documentation-heavy, so payers can easily verify and pay. Many clients report that payers respect the formal, systematic approach. You're not emotionally demanding; you're contractually entitled.

Revenue Teardown

Dollar-by-dollar breakdown of underpayment leakage at a real practice. See the exact patterns your EHR misses.

View Teardown

Your Assessment

We check every payment against every payer contract. Typical finding: $100K+ in underpaid claims you never caught.

See Your Numbers

See what's hiding in your payments

ANKA runs a Complimentary assessment of your last 12 months of payments. We check them against your contracts. If we find underpayments, we tell you the dollar amount. If we find none, you've lost nothing and learned something. Complimentary for qualified organizations (10+ providers).

Start Your Complimentary Revenue Cycle Assessment

5–10 business days. Typical finding: $100K+.