ANSWERS · REVENUE CYCLE

How do I know if I'm being underpaid by insurers?

You find underpayments by comparing the allowed amount on each remittance line to your contracted rate for that code — not by looking at denials, because underpayments come on claims that already paid. Most practices never do this line-by-line, so the losses stay invisible and repeat on every claim until the payer's fee schedule is corrected.

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What actually matters

  • Load your contracted fee schedules by payer and compare the allowed amount on every paid line against them
  • Watch for the common patterns: below-fee-schedule pricing, misapplied MPPR, modifier reductions, silent-PPO discounts, and outdated rates
  • Underpayments often have no denial code at all, so nothing in your PM system flags them
  • Because they're systematic, one wrong loaded rate underpays every claim in that code family until you catch it
  • Recover retroactively back to the effective date, and reconcile in batches, not one claim at a time

Common questions

Why don't underpayments show up as denials?

Because the claim paid. Nothing rejected, so no denial code and no worklist item is created. The only way to see an underpayment is to compare the allowed amount to what your contract says you were owed.

Where Volari fits: Underpayment reconciliation is one of Volari's two lanes — see your exposure by uploading your remittances at /underpayment-recovery.

Related answers
How do I lower my practice's denial rate?How do I reduce days in A/R?How do I read an EOB or 835 remittance?In-house billing vs. outsourcing: which is right for my practice?How do I renegotiate payer contracts for better rates?How do I fix my prior-authorization workflow?

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