How Datatech Identified and Recovered 6-Figure Revenue for a Specialty Clinic
🩺 The Hidden Problem No One Talks About
In medical billing, everyone worries about claim denials — and rightfully so. But there’s another threat quietly draining revenue from healthcare providers: chronic underpayments.
Unlike denials, underpayments are subtle. They don’t come with obvious rejection codes or alerts. Instead, they slip through — a few dollars short on one claim, a miscalculated adjustment on another. Over time, they build into a massive loss most practices don’t even know they’ve suffered.
This was exactly the case for one of our clients: a multi-specialty clinic offering neurology, gastroenterology, and pain management services. Their collections looked “normal” on paper — but something didn’t add up.
🧮 The Discovery: A Pattern of Loss
The client approached Datatech RCM Solutions after noticing that their expected monthly collections were trailing by 10–12%, even though claim volumes and approval rates were stable.
When our audit team dove in, the findings were shocking:
- Over 1,800 claims had received partial payments — not denials, but short reimbursements.
- Payers had applied incorrect contracted rates, outdated fee schedules, or improper bundling.
- Adjustments weren’t being cross-checked against EOBs and payer contracts.
- No systematic process existed to track allowed amounts vs. paid amounts.
In short: they were leaving money on the table, every day.
🛠️ The Datatech Fix
Our response involved both forensic auditing and system transformation.
🔍 1. Contract Audit & Benchmarking
- Retrieved payer contracts and historical rate agreements.
- Built a custom “Allowed Amount Matrix” for each CPT code by payer.
- Cross-referenced paid claims against expected amounts from fee schedules.
💰 2. Underpayment Detection Algorithm
- Deployed proprietary scripts inside the PM system to flag payment mismatches.
- Identified claims with discrepancies greater than $5 — even if marked “paid” in the system.
📞 3. Targeted Recovery & Reconciliation
- Created a task queue of flagged claims.
- Our A/R specialists launched direct appeals with supporting documentation and EOB comparisons.
- Recovered additional payments through reprocessing, contract corrections, or adjustment reversals.
📊 4. Real-Time Underpayment Tracker
- Built a live dashboard for the client to view:
- Underpayment volume by payer
- Discrepancy reasons
- Recovered vs. pending amounts
📈 The Results
Over a 10-week period, Datatech recovered $132,400 in underpaid amounts — revenue the client never expected to see again.
| Metric | Outcome |
|---|---|
| Claims Reviewed | 2,137 |
| Underpaid Claims Identified | 1,812 |
| Revenue Recovered | $132,400 |
| Avg. Underpayment Per Claim | $73 |
| Top Payers Involved | Medicare Advantage, Aetna, UHC |
More importantly, we integrated permanent safeguards so the issue wouldn’t repeat:
- Automated underpayment flags on every posted payment
- Quarterly contract reviews
- Monthly underpayment variance reports delivered to the CFO
“I always thought we were collecting everything we were owed. Turns out, we were bleeding money in silence. Datatech changed everything.”
