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Paid vs contracted-
checked line by line
Experienced reviewers
claim-level review
Small-dollar recovery
the losses too small to chase
Underpayment recovery
on claims marked paid
The losses that hide by being small.
A big denial gets noticed and fought. A $3 shortfall does not trigger action. No one has time to call a payer over USD 3. So the small stuff is never chased, and payers, whether by system lag or quiet adjustment, keep landing just under the line where you'd react. The losses aren't hidden because they're complicated. They're hidden because they're small.
Across the 35 private practices we've analyzed, an average of 5–8% of revenue quietly disappears this way. For a $3M practice, that can mean USD 150K to USD 240K per year, built almost entirely from amounts no one would chase one by one.
See where it's goingWhat 5–8% looks like on a $3M practice
The 5–8% range reflects OneMed's analysis of 35 private practice revenue cycles; the dollar figures apply that range to a $3M example practice. This range covers revenue recovered (underpayments, fee-schedule gaps) and does not fold in internal operating costs like staff time. Your actual exposure depends on payer mix, contract terms, and front-end workflow.
You negotiated that rate. They just didn't pay it.
This is the loss that stings most because it is not a gray area. It is your own contract not being honored. New rates take effect, the payer's system never gets updated, and they pay you a couple of dollars under what you both agreed. Too little to notice on any one visit. A silent pay cut across a year of them.
One visit. The rate you agreed vs the rate they paid.
agreed
Illustrative figures shown for clarity. The size of the gap and the number of affected visits vary by payer, contract, and specialty.
Five leaks, none of them worth chasing alone.
That's the trap. Each shortfall is small enough to ignore on its own. Across a year and across every payer, those small gaps become real money.
The rate you agreed, quietly cut
Every year you negotiate a contracted rate with each payer. When new rates take effect, payer systems do not always update correctly. They may pay a few dollars below the contracted rate on visit after visit. This is not a coding judgment or a gray area. It is the rate both parties signed, not being honored.
The claim that says paid but wasn't
Your team fights denials. A claim marked paid often gets no second look, even when it was paid USD 15 or USD 20 short because of a coding difference or quiet bundling issue. Across thousands of claims, those little shortfalls are tens of thousands of dollars a year.
Rework instead of collection
A clean claim costs a few dollars in staff time. A rejected claim caused by a typo, eligibility miss, or missing information can cost many times more to investigate, correct, and resubmit. When the front end is weak, your skilled billers spend their week fixing preventable errors instead of collecting real, aged money.
Turnover that stalls the cash
Billing has some of the highest turnover in healthcare. When an experienced biller leaves, the practice loses institutional knowledge too. Submissions slow, aged debt stalls, and denials rise while a new hire learns your payers and workflows.
The balance the front desk couldn't catch
When a copay or deductible is not collected at the desk because the front office is busy or eligibility was not checked, the balance moves to the back office. Chasing small patient balances months later often fails. The patient is annoyed, the balance ages, and it becomes bad debt.
Bandwidth, not effort
Nobody on your team is doing anything wrong. They're triaging thousands of claims a month, and the rational move on a three-dollar gap is to let it go.
Each loss is too small to chase
No one should have to call a payer over USD 3. The rational call on any single small gap is to let it go, which is exactly how the aggregate grows unwatched.
Built to fight denials, not underpayments
Your team chases claims marked denied. A claim that is paid but paid short often moves through unnoticed because underpayments do not announce themselves the way denials do.
You can't see it from the deposit
One number a month can't reveal a fee-schedule gap or a short-paid claim. The leaks live on individual lines, invisible from the top, and you can't manage what you can't measure.
We chase the small stuff, so your team doesn't.
These losses are not worth a person’s time one by one. They need a system checking every claim and a specialist stepping in only when the recovery is worth pursuing. That's the model: continuous checking on the small-dollar gaps, human recovery on the ones worth appealing, and front-end fixes so they stop recurring. All inside the systems you already use.
Compare every payment to your contract
Our ClearView dashboard compares what each claim was paid against what your contract says it should have paid. It surfaces outdated fee schedules and short-paid claims that would never be caught manually.
Recover the gaps worth appealing
When a payer pays below contract, our reviewers build a specific appeal and pursue it, including quiet underpayments on claims your team had no reason to reopen.
Fix the front end so it stops leaking
We put real-time eligibility checks and point-of-service collection steps in place, so fewer claims reject and fewer balances slip to the back office in the first place.
Steady the cash through the rough patches
Our team works alongside yours so staff turnover or a busy period does not stall submissions or aged follow-up. Cash keeps moving even when a seat is empty.
The 2026 OneMed Private Practice Profit Index.
We reviewed anonymized results from every private practice we worked with over the last 18 months. The patterns became clear once small-dollar gaps were tracked instead of only denials.
35
private practices analyzed
1.8M+
claims reviewed
$155K
average recovered per practice
↓ 42%
average rework cost
Point-of-service collections rose 28% on average. This is where the gains came from: a mix of revenue recovered from payers and operating cost removed from the practice.
| Where the money was found | Share of the total |
|---|---|
| Front-end rework reduced (cost saved) | 35% |
| Outdated fee schedules corrected (revenue) | 24% |
| Point-of-service collections improved (revenue) | 18% |
| Underpaid "paid" claims recovered (revenue) | 15% |
| Turnover impact cushioned (cost avoided)/td> | 8% |
Aggregated across OneMed private practice engagements over the trailing 18 months. Individual results vary by practice, payer mix, contract terms, and starting point. Some categories represent revenue recovered from payers. Others represent cost removed from your own operation. Both improve margin, but they are not the same thing.
Who We Serve?
Small-dollar recovery and full-cycle billing for private practice.
Independent solo practices
Owner-operated practices where a few percent of margin is the difference between a good year and a hard one.
Small physician groups
Two-to-ten provider practices with real claim volume and a small billing team that can't chase every small gap.
Community & rural practices
Broad-scope practices billing a wide payer mix, where fee-schedule lag and short-pays hide easily.
Specialty private practices
Single-specialty offices where consistent contract enforcement across a high claim count protects the bottom line.
Your practice data, handled properly
A signed agreement is in place before any protected data changes hands, and everything is handled in a controlled, auditable environment.
Paid vs contracted, on your own claims.
You don't need to hand a new vendor months of records to find out whether this is real. Pull ten recent payment records, remove the patient details, and we will compare what was actually paid against what your contract says should have been paid in a live 15-minute review.
- 1 · Pull ten payment records, including a mix of standard visits, chronic-care visits, and in-office procedures.
- 2 · Remove patient details, including names, dates of birth, and member IDs. We only need the codes and amounts.
- 3 · Send them securely through our portal before the call.
- 4 · Review them live with us to see outdated fee schedules, short-paid claims, and front-end leakage.
Request received.
Thank you. A member of our team will review your information and be in touch within one business day. We look forward to showing you what your practice should be collecting.
Common questions.
If the losses are only a few dollars each, do they really matter?
If the losses are only a few dollars each, do they really matter? That's exactly why they matter. A $3 shortfall on one visit is invisible, so nobody chases it. The same $3 across twelve thousand visits is a full salary. Private practice loses money not to big dramatic denials but to tiny amounts, repeated thousands of times, that sit below the threshold anyone has time to notice.
What is fee schedule shrinkage?
You negotiate a contracted rate with each payer. When new rates take effect, payers don't always update their systems, so they quietly pay you a couple of dollars less per visit than your own contract says. The gap is too small to trip any alarm, but across a year of visits it's a silent pay cut you never agreed to.
Our claims say paid. Isn't that fine?
Not always. A claim can read as paid while quietly being $15 or $20 short of your contracted rate. Because it isn't denied, nobody reopens it. Across thousands of claims, those small shortfalls become tens of thousands of dollars a year that were simply never collected.
Do you make us change our EHR or billing system?
No. We work inside the systems you already use and adapt to your workflow, with no software change and no disruption to your clinic.
What happens on the 15-minute review?
Bring ten recent payment records with patient details blacked out, and we will show you where claims were underpaid using your own numbers. No bulk PHI upload.
Do we have to switch billing companies?
No. The review works alongside your current billing, and many practices start there before expanding.
Recover the money that hides by being small
Bring ten claims to a 15-minute review and see what was absorbed into the flat fee using your own numbers.