By Donzalee Johnson Baker, Co-Founder & President of Revenue Recovery, CareSync RCM Billing Experts

I recently reviewed the financials for a multi-provider mental health treatment center that was convinced their biggest problem was new patient volume. They wanted more referrals, more intakes, more admissions. Growth was the strategy.

But when I looked at their revenue cycle data, the picture was very different. They had more than $380,000 sitting in accounts receivable for the past 90 days. Over $140,000 of that was in denied claims that had never been appealed. Another $60,000 was in underpayments that no one had identified, let alone disputed. And roughly $45,000 was in claims that had been submitted to the wrong payer or with incorrect patient information, claims that could have been corrected and resubmitted but instead sat untouched in a queue.

This practice didn’t need more patients. It needed to collect on the patients it had already treated.

This is the problem I have built my career around, and it’s the reason I lead Revenue Recovery at CareSync RCM Billing Experts. Revenue recovery isn’t a back-office task you get to when operations slow down. It’s a discipline, and for many practices, it’s the single highest-impact financial intervention available, because you’re not generating new business. You’re collecting on business you’ve already done.

THE REVENUE YOU’VE ALREADY EARNED BUT HAVEN’T COLLECTED

Every healthcare practice has money sitting in its revenue cycle that it’s already earned but hasn’t collected. The question is how much and where it’s hiding.

The most common places are aged A/R (claims that were submitted but never followed up on), denied claims that were written off without appeal, underpayments that were accepted without review, credit balances that were never refunded or reallocated, and patient balances that were billed once and then forgotten.

In specialty environments, behavioral health, substance abuse, radiology and anesthesiology, the amounts are often larger because the billing is more complex. Higher claim values, more modifier-dependent reimbursement, more authorization-driven payer rules, and more variability in how payers process specialty claims all create more opportunities for revenue to fall through the cracks.

The tragedy is that most of this revenue is recoverable. Not all of it, but a significant portion, if someone is looking for it, knows how to find it, and acts within the payer’s dispute and appeal timelines.

WHAT MOST PRACTICES GET WRONG

The biggest mistake is treating write-offs as inevitable. I have seen practices with contractual adjustment rates that look reasonable on the surface, but when you dig into the detail, 15% to 20% of what they’re writing off isn’t a true contractual adjustment, it’s an underpayment, a denied claim they didn’t appeal, or a balance they gave up on too early. They have essentially categorized lost revenue as “normal” because no one questioned it.

The second mistake is not having a structured aging follow-up process. Many practices work A/R by age bucket, they focus on the newest claims first and let the older ones slide. This is backwards. The oldest claims are the closest to the timely filing deadline, which means they have the most urgency. Every day a claim sits unworked past 60 days, the probability of collection drops.

The third mistake is underestimating the value of small-balance recoveries. A practice might write off a $35 underpayment because it doesn’t seem worth the effort to dispute. But if that underpayment happens 500 times a year across your payer mix, you’ve just written off $17,500. Revenue recovery isn’t about chasing individual claims, it’s about identifying patterns where small losses compound into significant revenue.

The fourth mistake is not auditing payer payments against contracted rates. This is closely tied to contract management, but it lives in the recovery space because underpayment identification is where the money actually gets found. If your billing system isn’t flagging payments that fall below contracted rates, you’re relying on manual review, which means you’re missing the majority of underpayments.

THE REVENUE RECOVERY FRAMEWORK

At CareSync RCM, our recovery approach follows a four-phase process: Audit, Prioritize, Act, and Systematize.

Audit - We start with a forensic review of your A/R, focusing on claims aged 60+ days. We categorize every outstanding balance by status: pending payer response, denied and not appealed, denied and appeal in progress, underpaid and not disputed, patient balance with no follow-up, and claims with correctable errors that were never resubmitted. This gives us a complete picture of your recovery universe, the total amount of revenue that’s at risk or already lost.

Prioritize -  Not all recoverable revenue is equally urgent or equally accessible. We rank recovery opportunities by three factors: dollar amount, deadline urgency (how close the claim is to the timely filing or appeal deadline), and probability of recovery (based on denial category, payer history, and documentation strength). This ensures we work the highest-value, most time-sensitive recoveries first.

Act - This is where the work happens. For denied claims, we prepare and submit targeted appeals with supporting documentation, clinical notes, and payer-specific language. For underpayments, our approach is different from other billing companies, especially when it comes to out-of-network providers. For out-of-network underpaid claims, we implement our back-end negotiation process where we tackle third party companies first. For underpaid claims for our  in-network providers, we ensure that those fee schedules are being reviewed thoroughly and are honored by the payer. For corrected claims, we fix the error and resubmit. For patient balances, we implement structured outreach sequences. Every action is tracked with deadlines, expected response dates, and escalation triggers.

Systematize - Recovery is not a one-time project. The practices that sustain healthy A/R are the ones that build recovery discipline into their ongoing workflow. That means weekly A/R review meetings, real-time denial tracking, automated underpayment flagging, and monthly recovery reporting that shows dollars recovered, recovery rate by category, and trending patterns. When you systematize recovery, you stop having periodic “clean-up” projects and start maintaining a healthy revenue cycle continuously.

I want to emphasize something about this last phase, because it’s where most recovery efforts stall. Practices will do the audit, prioritize the backlog, work through a stack of appeals, and recover a meaningful amount of revenue. Then they go back to business as usual, and within six months, the same backlog has rebuilt itself. The reason is simple: they treated recovery as a project instead of a process. At CareSync RCM, we build recovery workflows that run continuously alongside daily billing operations, not as a separate initiative. Recovery becomes part of how the practice operates, not something that happens when the problem gets bad enough to notice.

THREE THINGS YOU CAN DO THIS WEEK

First, pull your A/R aging report right now and look at the 90+ day bucket. How much is sitting there? What percentage of it is denied claims? What percentage is unworked? That number is your immediate recovery opportunity, and it’s also a measure of how much revenue your current process is letting walk away.

Second, review your write-off reports for the last six months. Look for patterns: Are you writing off the same denial categories repeatedly? Are there specific payers where write-offs are disproportionately high? Those patterns are signals, they’re telling you where your process has a gap.

Third, check your payer appeal deadlines. Many practices discover too late that their window for filing appeals or disputing underpayments has closed. Build a simple tracking sheet that lists every payer’s appeal deadline, timely filing limit, and dispute submission requirements. This one document can save you thousands in recoverable revenue. I’ve seen practices recover five-figure sums simply because they started tracking deadlines and caught claims before the window closed, claims they would have written off the month before because nobody knew the deadline was approaching.

WHY REVENUE RECOVERY IS BECOMING MORE CRITICAL

The financial pressure on healthcare practices isn’t letting up. Reimbursement rates are flat or declining in many specialties. Operating costs, staffing, technology, compliance, continue to rise. And payer behavior is getting more aggressive: tighter authorization requirements, more complex claim processing rules, and shorter dispute windows.

In this environment, the practices that maintain financial health won’t be the ones that see the most patients. They’ll be the ones that collect on every dollar they’ve earned. Revenue recovery is shifting from a “nice to have” to a survival competency.

This conviction is at the heart of why my co-founders and I started CareSync RCM Billing Experts. We spent our careers watching recoverable revenue disappear, not because it couldn’t be collected, but because no one was looking for it. We built CareSync to change that. We recover 20% or more of revenue that practices typically lose, and we do it through forensic analysis, systematic workflows, and relentless follow-through.

If you suspect there’s revenue sitting in your A/R that should have been collected months ago, you’re probably right. CareSync’s Free Forensic Revenue Health Check is designed to surface exactly those indicators: aged A/R patterns, denial recovery opportunities, underpayment risk, and workflow gaps that are letting revenue slip away. It’s a no-cost diagnostic, not an audit, not a guarantee, not a pressure conversation. Just clarity on where the money is and what to do about it.

DM CHECK or visit caresyncrcm.com. The revenue is yours. Go get it.

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