Are appeals actually worth the effort?

Yes — industry data shows roughly half of appealed denials are overturned, yet most denials are never appealed at all. The economics strongly favor a disciplined appeals process, especially on high-dollar claims.

What is an underpayment recovery project?

We audit a period of paid claims against your contracted rates, identify systematic underpayments, and pursue recovery with the payer — typically finding 3–7% of revenue paid below contract.

Revenue Recovery

Appeals & Revenue Recovery

Evidence-built appeals through every level — clinical documentation, payer policy citations, and persistence that recovers what you earned.

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Business outcomes

What this changes for your organization

Appeals & Revenue Recovery · performance standards

measured continuously

average appeal overturn rate

58%

of revenue recovered in underpayment audits

3–7%

appeals filed within payer deadlines

100%

Performance standards we operate to. Actual results vary by specialty, payer mix, and starting position — your free assessment establishes your own baseline.

Our solution

When a payer wrongly denies or underpays, an appeal is your legal right — and a well-built appeal wins more often than most practices believe. Our appeals team constructs each case with clinical documentation, payer policy citations, coding guideline references, and medical necessity support.

We pursue appeals through every available level — reconsideration, formal appeal, external review — and run systematic underpayment recovery projects that audit paid claims against contracts to reclaim the difference.

What's included

First- and second-level appeal preparation
Clinical documentation and policy citation support
External review and state DOI escalation
Underpayment audit against payer contracts
Timely-filing and retro-authorization appeals
Recovery reporting by payer and issue

Common questions