By James Werner
Strong productivity does not always translate into strong collections.
For physician practices and ambulatory surgery centers (ASCs), improving financial performance often brings familiar strategies to mind: increase patient volume, add providers, improve scheduling or renegotiate payer contracts. But in a margin-compressed environment, there is another question leaders should be asking:
Are we collecting the revenue we have already earned?
Payer underpayments can quietly erode financial performance. A relatively small difference between expected and actual reimbursement may seem insignificant on a single claim. Repeated across hundreds or thousands of encounters, procedures and surgical cases, however, those differences can materially affect net revenue.
The challenge is that underpayments are not always obvious. They can result from contract terms, fee schedules, coding or modifier issues, payer edits, authorization requirements, payment policies or other reimbursement complexities. Without a disciplined way to compare expected reimbursement with actual payment, practices may not recognize the pattern until significant revenue has already been lost.
An HFMA survey of 125 healthcare finance executives found that 22% identified revenue integrity as their organization’s leading priority, yet fewer than half had established formal revenue integrity programs.[1]
For practice and ASC leaders, that gap points to an opportunity: better visibility into payer performance can help identify missed revenue, strengthen contract compliance and inform future payer strategy.
Better Decisions Start with Better Reimbursement Data
Practices and ASCs need reliable data to answer two different—but equally important—questions:
Are payers reimbursing us according to our contracts? And are those contracts competitive in the first place?
Answering the first requires comparing expected reimbursement with actual payments. Leaders should be able to identify variances by payer, procedure, code, modifier and location—and determine whether those differences represent isolated issues or recurring patterns.
The second question requires a broader market perspective. Price transparency data can provide another point of reference by helping organizations compare negotiated commercial rates and identify areas where reimbursement may be out of line with the market.[5]
Together, these insights can give leadership a clearer picture of both contract compliance and contract performance.
Questions Leaders Should Be Asking
A stronger revenue integrity strategy starts with practical questions:
- Are our payer contracts competitive?
- Are we consistently receiving the reimbursement our contracts require?
- Which payers, procedures or locations account for the largest payment variances?
- Are recurring issues connected to payer behavior, coding and documentation, authorization, charge captureor contract terms?
- Do we have a consistent process to identify, prioritize, appeal and recover underpayments?
- Are we using what we learn from underpayments to improve future payer negotiations and internal processes?
These questions matter because recovering underpayments generally does not require additional patients, providers or operating room capacity. Improving reimbursement accuracy can help protect net revenue using the volume the organization already has.[2][4]
That makes revenue integrity particularly important when margins are under pressure.
Turn Price Transparency into a Strategic Tool
Price transparency data adds another dimension to the analysis.
Contract compliance asks: Did the payer reimburse us correctly under the agreement we have?
Market data helps leaders ask: Is the agreement itself competitive?
That distinction matters. A payer may reimburse every claim correctly while the underlying contract still produces reimbursement that trails relevant market benchmarks.
Used thoughtfully, market-rate information can help practices and ASCs identify contracts that warrant closer evaluation, strengthen their position in payer discussions and focus attention where the financial opportunity may be greatest.[5]
Build Revenue Integrity into Ongoing Financial Management
Underpayment recovery should not be a one-time exercise.
A sustainable approach connects contract management, expected reimbursement modeling, claims and remittance analysis, recovery efforts and ongoing monitoring. It should also help leadership trace reimbursement problems back to their root causes—whether those involve payer policies, coding, documentation, charge capture, authorization processes or contract language.
The objective is bigger than recovering missed dollars.
It is creating enough visibility to understand how payers are performing, where revenue is being lost and what the organization can do about it.
With that information, physician practices and ASCs can make more informed decisions about payer relationships, operational improvements and future contract negotiations.
Protect the Revenue You Have Already Earned
In a challenging financial environment, growth is important. But protecting existing revenue matters, too.
Regularly comparing expected reimbursement with actual payments can help physician practices and ASCs identify underpayments earlier, address recurring issues and strengthen accountability across both payer relationships and internal operations.
The opportunity is not simply to recover yesterday’s missed revenue. It is to build a more disciplined approach that helps prevent tomorrow’s.
Newsletter Takeaway
Underpayments can be easy to miss because a paid claim can look like a completed transaction. Comparing expected reimbursement with actual payments can help physician practices and ASCs identify revenue leakage, strengthen contract compliance and make more informed payer decisions.
How Sorren Can Help
Understanding where reimbursement is falling short is the first step. Determining why—and what to do next—is where deeper analysis can make a difference.
Sorren helps physician practices, ASCs and other healthcare organizations evaluate reimbursement and payer performance with greater clarity. Our healthcare professionals combine financial analysis, market intelligence and reimbursement experience to help identify payment issues, evaluate contract performance and support more informed payer and business decisions.
Our capabilities include reimbursement analysis, valuation, compliance and litigation support for healthcare providers, counsel and organizations across the continuum of care.
Connect with Sorren’s healthcare team to explore where your organization may have opportunities to strengthen reimbursement performance and protect net revenue.
References for Peer Review
[1] HFMA, “Revenue integrity — minding the gaps between clinical operations, coding and billing,” September 16, 2019, updated November 7, 2022.
[2] HFMA MA/RI Chapter Blog, “The Revenue You’ve Already Earned: Recovering Underpayments from Zero-Balance Accounts,” May 5, 2026.
[3] HFMA, “Boost charge capture by bridging gaps between teams,” September 11, 2025, updated September 23, 2025.
[4] Revenue Synergy, “Payer Underpayment Recovery: Find the Money You’re Owed,” June 5, 2026.
[5] American Billing Association, “Underpayment Recovery: Catch What Payers Owe,” updated June 2026. diness for potential coverage disruption.
