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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 three-dollar shortfall doesn't — there's no version of your day where anyone picks up the phone over three dollars. 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. On a $3M practice that's $150K–$240K a year — assembled almost entirely out of amounts no one would ever chase individually.
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 one that stings the most, because it isn't a grey area — it's your own contract, not 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 is small enough to wave off, and it's only in aggregate — across a year, across every payer — that they turn into real money.
The rate you agreed, quietly cut
Every year you negotiate a contracted rate with each payer. When new rates take effect, their systems don't always update — so they pay you a couple of dollars under your own contract, on visit after visit. It's not a grey area or a coding judgement. It's the number you both signed, not honored.
The claim that says paid but wasn't
Your team fights denials. A claim marked paid gets no second look — even when it landed fifteen or twenty dollars short because of a small coding difference or a quiet bundle. 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 one — a typo, an eligibility miss, missing information — costs many times more to investigate, fix 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 institutional knowledge goes too — and for months, submissions slow, aged debt stalls, and denials climb while a new hire learns your payers.
The balance the front desk couldn't catch
When a copay or deductible isn't collected at the desk — because the front is slammed, or eligibility wasn't checked — the balance moves to the back office, where chasing a small amount months later mostly 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
Nobody picks up the phone over three dollars — and they shouldn't have to. 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 was paid, just paid short, sails through — because nothing flags an underpayment the way a denial announces itself.
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.
The whole point is that these losses aren't worth a person's time individually — so they need a system watching every claim, and a specialist stepping in only where it pays to. 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 checks what each claim was actually paid against what your contract says it should have been — surfacing outdated fee schedules and short-paid claims that would never be caught by hand.
Recover the gaps worth appealing
Where a payer paid below contract, our reviewers build the appeal with the specifics and pursue it — including the 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 a departure or a busy stretch doesn't stall submissions and aged follow-up — the cash keeps moving even when your seat is empty.
The 2026 OneMed Private Practice Profit Index.
We aggregated the anonymized results from every private practice we worked with over the last 18 months — here's what surfaced once someone watched the small-dollar gaps instead of only the 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. Here's where the gains came from — a mix of revenue recovered from payers and cost taken out of your own operation.
| 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. Note that some categories above are revenue recovered from payers and others are cost removed from your own operation — both improve your 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, black out the patient details, and we'll compare what was actually paid against what your contract says should have been — live, in fifteen minutes.
- 1 · Pull 10 payment records — a mix of standard visits, chronic-care visits, and in-office procedures.
- 2 · Black out the patient details — names, dates of birth, and member IDs. We work from the codes and amounts.
- 3 · Send them securely — into our secure portal before the call.
- 4 · See it live — outdated fee schedules, short-paid claims, and where the front end is leaking.
Book your 15-minute review
We'll confirm a time within one business day.
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 — no software change and no disruption to your clinic.
What happens on the 15-minute review?
You bring ten recent payment records from your most complex specialty with patient details blacked out, and we show you where specialty rules were misapplied or a complex procedure was 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 you're being paid below contract — using your own numbers.