How to recover a Site-of-Service Payment Differential underpayment
A site-of-service differential underpayment is when a service performed in your office is paid at the lower facility rate, or against the wrong place-of-service pricing, so you're shorted the non-facility payment that includes practice-expense overhead you actually incurred. The claim pays; it just pays at the wrong site's rate.
How it shows up: An office-based service paid at a facility rate (or the wrong site differential) — a lower allowed with no denialWhy it happens
- The payer priced a non-facility (office) service at the lower facility rate
- The place-of-service code was correct but the payer's pricing used the wrong differential
- A POS mismatch routed the line to facility pricing
- The non-facility practice-expense value wasn't applied to an in-office service
What recovers it
- Compare the allowed against the correct non-facility rate for the POS on the claim
- Confirm the place-of-service code reflects the office and request non-facility pricing
- Show the service carried practice-expense overhead the office setting warrants
- Request repricing to the correct site differential, back to the effective date
Worth recovering? The office-versus-facility differential is real money the non-facility rate is meant to cover your overhead, and paying an in-office service at the facility rate quietly strips that out. It only surfaces by checking the allowed against the right site's rate.
Common questions
How do I recover a Site-of-Service Payment Differential underpayment?
A site-of-service differential underpayment is when a service performed in your office is paid at the lower facility rate, or against the wrong place-of-service pricing, so you're shorted the non-facility payment that includes practice-expense overhead you actually incurred. The claim pays; it just pays at the wrong site's rate. To recover it: compare the allowed against the correct non-facility rate for the POS on the claim; confirm the place-of-service code reflects the office and request non-facility pricing; show the service carried practice-expense overhead the office setting warrants; request repricing to the correct site differential, back to the effective date. Because the claim already paid, the hard part is catching it, reconciling the allowed amount against what you were actually owed.
Is a Site-of-Service Payment Differential underpayment worth recovering?
The office-versus-facility differential is real money the non-facility rate is meant to cover your overhead, and paying an in-office service at the facility rate quietly strips that out. It only surfaces by checking the allowed against the right site's rate. A no-risk service makes it easy to find out, you only pay on what's actually recovered, so there's no cost to surfacing the ones that are real.
How does Volari find Site-of-Service Payment Differential underpayments?
Volari reconciles every remittance line's paid and allowed amounts against what your contract and the payer's own rules say you should have been paid, surfaces the site-of-service payment differential shortfalls no one flagged, and works the recovery. You pay 25% only on what's recovered, and nothing if nothing comes back.
Volari's AI agentic crew that works your pile
The same AI agents that reconcile every line and recover your site-of-service payment differential underpayments inside the app, each a specialist at one part of the fight, paid only on what they bring back.
See what you were underpaid, line by line.
Upload your remittances and Volari reconciles every paid amount against what you were owed. No risk, paid only on what we recover.