QUALITY FIRST

Medical Underpayment Recovery Services

Hospitals Lose Millions Every Year... and Think It’s Normal. Let’s get brutally honest. “Payers have teams of analysts trained to reduce reimbursements. Do you?” At HMS USA LLC, we bring Wall Street-level audit firepower to your underpayment problem.

Hunt Buried CPT Denials | Short Pays | Contract Loophole

Book An Appointment

Still Trusting the Same Billing Reports While Losing $1M a Year?

Denials. Contract misinterpretations. Bundled payments gone wrong. They’re not bugs in the system. They are the system.

At HMS USA LLC, we don’t accept what payers offer. We go line by line, claim by claim, contract by contract—until we find the gap, and fill it.

And when we recover that lost revenue? You’ll wonder how you operated so long without us. Don’t call us unless you want to face the uncomfortable truth—and fix it.

Revenue recovery pays itself
Alternate Text TRUTH #1

Payers Are Trained to Pay You Less

They have analysts. You have overwhelmed billing staff. Guess who wins?

STAT

87% of hospital executives admit they lack real-time insight into claim underpayments.

Alternate Text

CLAIM PAID*

*not in full
Alternate Text TRUTH #2

You're Not Tracking the Right Numbers

Your monthly billing reports show collections. Not losses.

STAT

Up to 3-5% of total revenue is lost to unnoticed underpayments every year.

$5,000,000

Annual Revenue


$150,000+

Revenue Evaporating

Alternate Text TRUTH #3

Most Billing Teams Don't Have Time to Investigate

Claim volume, denials, appeals... They're in survival mode—not recovery mode.

STAT

Less than 12% of denied claims are ever reworked after initial denial.

Alternate Text

7 min

Time per claim

VS
Alternate Text

45 min

Time needed

"You think you're at 95% collection. You're actually at 85%.
The 10%? It's on the floor—and no one's picking it up."

Our Hospital Underpayment Recovery Service Is Built for Organizations Like Yours If…

Alternate Text

You operate on thin margins, where every $1K matters

Alternate Text

You've seen a spike in vague payer adjustments

Alternate Text

Your billing team is maxed out and under-resourced

Alternate Text

You haven't done a line-item audit in the past 12 months

Alternate Text

You suspect underpayments but don't have proof.

Alternate Text

Our best clients don't have a "collections" problem—they have a visibility
problem. And we solve it.

We Built a Healthcare Underpayment Recovery System That Leaves Nothing Behind

Alternate Text
Contract-to-Claim Reconciliation

We match your contracted rates to each claim line to detect miscalculations.

Our proprietary matching algorithms compare your exact contracted rates with the precise payment received on each claim line. We identify variances as small as a few dollars that add up to substantial amounts over time.
Alternate Text
Underpayment Pattern Detection

Our proprietary tools identify recurring underpayment trends across payers.

We analyze thousands of claims to identify systematic underpayment patterns. This allows us to detect when a payer is consistently applying incorrect rates or rules across multiple claims.
Alternate Text
Clinical + Code Validation

We validate all modifiers, bundled codes, and challenge incorrectly grouped procedures.

Our clinical team reviews the medical necessity and coding accuracy of each claim to ensure proper modifier usage and code bundling practices. We challenge inappropriate payer bundling and downcoding.
Alternate Text
Targeted Recovery Action

We re-open claims, file disputes, and escalate high-value cases for maximum recovery.

Once underpayments are identified, our recovery specialists pursue each case with customized strategies based on payer contracts. We initiate disputes, appeals, and when necessary, escalate to supervisory levels for resolution.
Alternate Text
Transparent Reporting

We show you every dollar we recovered and where it was hiding.

Our detailed reporting platform provides complete visibility into every recovery action. You'll see which claims were recovered, the exact underpayment amount, and the specific contract clauses that were violated.

5 Sources of Underpayments in Hospitals (That We Actively Recover)

Alternate Text
Contractual
Miscalculations
Misapplied rates, outdated terms.
Alternate Text
Modifier & CPT Code
Denials
Especially 25, 59, and 91 modifiers.
Alternate Text
Bundled Payment
Confusion
Payments grouped without clinical logic.
Alternate Text
Timely Filing
Errors
Payer misclassification, not actual late filing.
Alternate Text
Secondary Payer
Fallout
Coordination of benefits issues no one tracks.

Most billing teams don't have the bandwidth—or the systems—to track this level of detail. That's where we come in

What Makes HMS USA LLC Different?

Feature Comparison

Your Billing Vendor Closes Claims. We Recover What They Miss
Other Billing Vendors HMS USA LLC
Audit depth Alternate Text Alternate Text High-level summary Alternate Text Line-by-line forensic review
Underpayment recovery Alternate Text Alternate Text Optional / ignored Alternate Text Core service
Denial management Alternate Text Alternate Text Reactive Alternate Text Proactive + contract-driven
Payer negotiation Alternate Text Alternate Text None Alternate Text Aggressive + data-backed
Result Alternate Text Alternate Text Surface-level clean-up Alternate Text Deep revenue recovery

We Build Custom Recovery Algorithms Based on Your Contracts

Your payer contracts aren't generic. So why would your recovery process be?

At HMS USA LLC, we build:

Alternate Text

Custom logic engines to match your contract language

Alternate Text

Payment models specific to your CPT mix and DRG weights

Alternate Text

Claim testing tools against actual historical payer behavior

That's why our hospital underpayment recovery rates consistently outperform industry norms—by 2.7x.

Revenue recovery pays itself

What a Hospital Audit Actually Uncovers

This Is What You See… vs What We See in a Hospital Underpayment Audit
Your View (Before Audit) HMS View (After Audit)
Denial Rate: 7%
Alternate Text 2.1% of those denials are payer error
Alternate Text Financial Impact:
$150K–$300K annually in recoverable denials for a mid-sized hospital
"Paid" Claims
Alternate Text 11% underpaid by $30–$125 per claim
Alternate Text Financial Impact:
$200K–$400K annually in recoverable underpayments for a mid-sized hospital
Write-Offs due to "Contractual Adjustments"
Alternate Text 38% were based on inaccurate rate logic
Alternate Text Financial Impact:
$150K–$350K annually in recoverable write-offs for a mid-sized hospital
Bundled Payments
Alternate Text 18% had missed unbundling opportunities
Alternate Text Financial Impact:
$100K–$200K annually in missed revenue for a mid-sized hospital
Closed Cases
Alternate Text 14% were recoverable with minimal effort
Alternate Text Financial Impact:
$50K–$150K annually in recoverable closed cases for a mid-sized hospital
Hover over each item to see the financial impact

Why HMS USA LLC Is the Last Hospital Underpayment Recovery Partner You'll Ever Need

When you've had enough of vague reports, 'clean claims,' and passive revenue leakage, there's only one name that stands between your hospital and every underpaid dollar it's owed.

Alternate Text

We Operate Outside the Red Tape

No slow approvals. No integration headaches. You give us access—we start recovering.

Alternate Text

Contract-Specific Algorithms—Built by Us, For You

We reverse-engineer your payer contracts and build forensic audit tools around your exact language."

Alternate Text

Line-Item Recovery. Not Just Denial Chasing.

Other vendors stop at denials. We go line by line, modifier by modifier, CPT by CPT.

Alternate Text

Zero-Risk Engagement

You don't pay unless we find money. And when we do—you'll wonder how much you've already lost.

Alternate Text

Real Reporting. No Fluff.

You'll see every dollar we recover,
how we found it,
and why it was missed.

Alternate Text

We don't sell hope. We deliver audits, evidence, and bankable revenue.

Hospitals bring us in when they're ready to get serious about reclaiming what's theirs.

We Don't Guess. We Prove.

What Clients Say About Us

Below, you will find feedback from some of our cherished clients. We are proud to have helped them reach their business goals, and we appreciate the kind words they have shared about our services.

Looking for a Medical Billing Quote?