The Hidden Revenue in Your Contracts

I nsurance companies know that many rural and community hospitals don’t have the staff or time to stay up to date on a rapidly evolving field. As budgets tighten, and more hospitals try to wrangle payments on their own, money gets left on the table.  

Healthcare organizations lose millions of dollars each year—not because of denials, but because of variances that go unnoticed. These small underpayments from payers often go unnoticed, especially when they’re not flagged by a denial code. 

If your team isn’t equipped with the right tools to identify and address them, you could be missing out on significant revenue. 

Getting Paid Less Without Getting Denied 

Many payers are moving away from overt denials and instead quietly reducing reimbursement rates. For example, recent policy changes—like Aetna’s shift on one-day inpatient stays—automatically downgrade claims to observation rates instead of denying them outright. 

On paper, it looks like you got paid. In reality, you were paid less than you were owed. 

Without a system that can detect that variance, these underpayments are never caught or appealed—and that’s exactly what payers are hoping for. 

Seeing What Others Miss 

While RCM partnerships can seem like an additional cost, or headache, working with an experienced team can help hospitals identify and recover the dollars hiding in plain sight.  

Experts track expected reimbursement for every claim, compare it to what’s actually paid, and flag discrepancies instantly. 

The result? A clear, actionable list of underpaid claims—plus a team that knows exactly how to pursue them. 

Why It Matters 

Underpayments aren’t one-time errors—they’re patterns. Identifying trends in payer behavior allows your organization to: 

• Strengthen contract negotiations. 
• Improve payer accountability. 
• Recover lost revenue efficiently. 
• Ensure long-term financial integrity. 

Getting Results 

In one recent analysis, MEDTEAM identified over $3 million in unworked variances for a single hospital simply by analyzing existing data. Many organizations already have the tools—they just need the right expertise to unlock their full potential. 

With our help, you can gain a clear view of your payer performance and a plan to close the gaps that impact your bottom line.