Claim Denials and Underpayments from Multi-Payer Coding Errors

$1,000,000–$1,800,000 per year in unrecovered Medicare revenue and compliance-driven write-offs related to documentation and coding errors, plus audit risk. • $1,500,000–$2,500,000 per year in preventable denials, underpayments, and manual rework cost tied specifically to employer-sponsored plan complexity within the broader $6.4M claim error burden. • $1.2M annually from Medicare underpayments (20% of baseline)

Ad-hoc requests to billing team for denial data; no dashboard; relies on monthly reports from billing software • Annual review of claims; manual CMS guideline cross-reference; hired external compliance consultant on ad-hoc basis • Coders maintain payer-specific cheat sheets, spreadsheets of contract rules, and personal note books; they rework denied and underpaid claims manually by cross-checking portals, emailing clinicians for missing documentation, and using their own memory to recall which payer accepts which codes/modifiers for each specialty service.