Questions
Every question we get asked. Answered the way we'd want them answered.
From the practice administrator's compliance checklist to the question physicians ask quietly at the end of the call. If it's not here, call us and we'll answer it straight.
Money & Pricing
How we get paid, and how you verify every dollar.
How do you get paid?
Two models, your choice. Model A (Performance Recovery): a percentage of dollars actually recovered, tiered by claim age: 12% for claims 0–90 days old up to 30% for 365+ days and prior write-offs. Nothing recovered means nothing owed. Model B (Flat-Rate): a fixed monthly rate based on claim volume and open AR, where every recovered dollar is 100% yours. Full tiers and the fine print are on the Pricing page.
What if you recover nothing?
Nothing at all. The audit is free, and under Model A we're paid only from dollars that actually post; the audit exists precisely so neither of us starts an engagement the numbers don't justify. We carry the risk of non-recovery and advance all the labor. That's the point of contingency pricing.
How do I know a "recovered" dollar was your doing and not ours?
"Recovered" is defined narrowly, in your favor: a dollar counts only when a payer payment or approved adjustment attributable to our work posts to your accounts. Payments already in flight before engagement, patient payments, and capitation or incentive payments are excluded. Every invoice comes with a line-item recovery report you can verify claim-by-claim against your own remits; you pay only on what you can see.
Why is the audit free? What's the catch?
There isn't a catch; there's a reason. The audit is a $500 analysis (a real analyst plus our AI pipeline reviewing twelve months of remit lines), and it genuinely costs us money to run. We give it away because it's the fastest way to show you the benefit of working with us: a board-ready report on your own AR, with an honest go/no-go, before you've paid a dollar. Because each one takes real hours, we run a limited number per month and prioritize practices with meaningful denied volume.
Why do older claims carry a higher contingency percentage?
Because they're a genuinely different job. A 30-day-old eligibility denial is a correction and resubmission; a 14-month-old, twice-denied claim needs appeal research, medical-records assembly, payer escalation, and often multiple appeal levels, all under shrinking deadlines, all advanced at our cost against a lower probability of recovery. The tiers track actual cost and risk, which is why most firms simply refuse to touch aged AR at all.
Are there setup fees, monthly minimums, or long-term contracts?
No setup fee, no monthly minimum on Model A, and no long-term lock-in on either model: 90-day initial term, then month-to-month with 30 days' written notice. On exit you keep all reports, appeal files, and documentation.
Is percentage-based pricing even legal in my state?
In most states, yes. A number of states restrict percentage-based fees for claims services under fee-splitting or corporate-practice-of-medicine rules; New York is the most cited example. Where our compliance review finds Model A restricted for your provider type, we offer the Flat-Rate program exclusively. Your state's situation is confirmed in writing during the Recovery Audit; nothing changes mid-engagement.
Wouldn't it be cheaper to hire an in-house denials person?
Run the math both ways; we'll help. A dedicated denials specialist costs salary, benefits, training, software, and turnover risk, and one person can only work so many appeals a week. Our flat-rate tiers are deliberately priced below the blended in-house cost of the work they replace, and the contingency model costs nothing until it produces. The honest answer for very large groups is sometimes "build the team," and if your audit says that, we'll tell you.
Trust & Control
You keep the money, the data, and the final say.
Do you ever touch our money?
Never. Payer payments flow directly to your accounts exactly as they do today. We have no lockbox, no trust account, and no authority to negotiate a settlement below contract rates without your written approval. We're paid from invoices you verify, after money you can see has posted.
Are you a collection agency? Will you ever contact our patients?
No and no. We pursue payers only: insurance companies that owe you for care already delivered. We never contact patients, never work patient balances, and never buy debt. Your patient relationships are untouched.
Why should we trust you without published case studies?
Because we refuse to invent them: results on our site will only ever be real, documented, and verifiable, and until we can publish that, we'd rather show you nothing than theater. In the meantime the engagement is built to prove itself: a free audit ($500 value) with a written go/no-go, a narrow definition of "recovered" you can verify against your own remits, and a month-to-month exit. You never have to trust us further than the last report.
Who actually does the work: AI, or people? Onshore or offshore?
Both, in the right order, and US-based. AI reads remits and denial codes at machine speed to score every claim by dollar value, overturn probability, and deadline; that's triage. Human specialists then write and file the appeals, because a medical-necessity argument is won by someone who knows how that payer responds, not by a template. No PHI leaves the United States.
What happens when we cancel?
You keep everything: every report, every appeal file, every piece of documentation we produced. Your data is yours. PHI is returned or destroyed per your BAA, and recoveries that post afterward from work already in flight are handled per the services agreement, spelled out before you sign, not discovered at exit.
Will you really tell us if it's not worth it?
Yes, in writing. Every Recovery Audit ends with a go/no-go recommendation, including "your AR is clean, you don't need us" when that's the truth. We only take engagements the audit justifies; signing a client the numbers don't support costs us more than it costs you.
Payer Relationships
The question doctors ask quietly: will this make payers angry?
Will aggressive appeals damage our relationship with payers?
Appealing a denial is a contractual and often statutory right; payers process appeals every day from every serious provider organization. What actually damages payer relationships is sloppy volume: blind resubmissions and boilerplate appeals with no basis. We do the opposite: documented, professional, payer-specific appeals filed only where a reasonable basis exists. Hospital systems fight every recoverable denial as a matter of routine; independent practices deserve the same posture.
Could this trigger an audit or prepayment review of our practice?
Appeals and reviews run on separate tracks: payer audits are driven by billing patterns, coding outliers, and data analytics on your claims, not by whether you appeal denials. What we file is corrective and evidence-based, which is the profile of a well-run practice, not a risky one. And because our root-cause reporting cleans up the upstream errors that actually attract payer scrutiny, most clients end up with a cleaner submission profile than before.
Do you appeal everything?
No. That's recovery theater, and it's in our fine print that we don't do it. We don't resubmit claims blindly to inflate activity metrics and we don't appeal claims with no reasonable basis. Roughly two-thirds of denials are recoverable per Advisory Board research; our job is to find your two-thirds and tell you the truth about the rest.
What if the payer just denies the appeal again?
Then we escalate: second-level appeal, and external or independent review where the plan and state provide it, tracked to a final decision you can see. The appeal ladder exists because first-level reviews get overturned constantly; federal data shows that when denied Medicare Advantage claims are actually appealed, more than half win. Persistence inside the process is the entire game.
Clinical & Documentation
For the physicians: your clinical judgment, defended clinically.
Who writes medical-necessity appeals? Do you actually understand clinical documentation?
Appeals that turn on clinical documentation get clinician-informed review before filing: the argument is made in clinical terms against the payer's own medical policy, not re-coded and re-fired in billing language. A medical-necessity appeal written by someone who can't read a chart loses; ours are built by people who can.
Will you ask our physicians to change how they practice or document?
We will never touch clinical decisions; that's yours, full stop. What our monthly root-cause reports will do is show, with data, where a documentation element (a missing face-to-face note, an unlinked auth number, a template gap) is causing repeated denials for care that was clearly appropriate. Whether to act on that is your call; most physicians want to know.
Payers keep denying care we know was necessary. Can you actually fix that?
This is exactly the denial class where fighting back works best, because the care was defensible; it just needs the defense written. Medical-necessity denials are argued from your documentation, the payer's published policy, and peer-reviewed standards of care, escalated to external review when the plan won't move. We can't promise any single outcome, but "denied because nobody argued back" is the most reversible thing in your AR.
Data & Compliance
For the administrators: PHI handling you can put in front of a compliance officer.
Is our data safe? Do you sign a BAA?
Yes, always, and before any PHI moves, no exceptions. We operate as a HIPAA Business Associate: PHI encrypted in transit (TLS 1.2+) and at rest (AES-256), unique logins with multi-factor authentication, audit logging of access, and minimum-necessary, role-based permissions reviewed quarterly. The full safeguards list is on our Compliance page, and compliance officers can request our BAA and security documentation any time.
What access do you need to our systems?
Read-only or report-level access: nothing that can change your data. We work inside Athena, eClinicalWorks, Kareo/Tebra, AdvancedMD, NextGen, Epic community deployments, and standard 835/837 files. If you'd rather export reports than grant access, that works too; the audit runs either way.
Who sees our data, and do you use it to train AI for other clients?
Access is limited to the team working your engagement, under minimum-necessary rules. We don't sell, license, or monetize PHI, and we don't use your data to train models shared across clients. On termination, PHI is returned or destroyed per your BAA's retention terms.
What happens if there's ever a breach?
We follow the HIPAA breach-notification rule (45 C.F.R. §§164.400–414) and your BAA: notification without unreasonable delay inside the BAA's stated timeframe, full cooperation on risk assessment and remediation, and support for any individual notifications. It's documented before you sign, not improvised after.
Working Together
What changes in your office, and what deliberately doesn't.
Do you replace our billing company or billing staff?
No. We're the exceptions unit. Your billing team keeps submitting claims and posting payments exactly as they do today. We take the pile they never have time for: the denials, the underpayments, the aged AR. Billing companies partner with us for the same reason, under their own brand.
Won't our biller feel like you're checking their work?
The framing matters, and we're careful with it: denials happen at every practice on earth (the industry average is more than one claim in ten), and working them is a specialist discipline that no general billing operation staffs deeply. In practice we make your biller look better: cleaner AR, recovered dollars on their reports, and root-cause fixes that cut their rework. Billing companies literally hire us for this.
How much of our staff's time will this take?
Almost none; that's the design constraint. Setup is the BAA plus read-only access or a handful of standard reports, typically one to two hours of your administrator's time total. After that, your side of the engagement is reading a weekly status report and a monthly root-cause report.
How fast will we see recovered money?
Honestly: first postings typically land 30–90 days after engagement, depending on payer and appeal level. Corrected resubmissions move fastest; multi-level appeals take longer. Anyone who promises you a specific number by a specific date is guessing; we set the expectation up front and report progress weekly instead.
Which payers do you work: Medicare, Medicaid, Medicare Advantage, commercial?
All of them, including Medicare Advantage plans, currently the fastest-growing source of denials and, when appealed, among the most winnable. Payer mix affects strategy (appeal levels, deadlines, and review rights differ), which is why the audit maps your denials payer by payer before anything is worked.
Are we too small for this to be worth it?
Small practices are who we built this for: a solo or three-provider practice feels denied revenue as personal income, and the contingency model means our economics scale down with yours. The free audit answers the question definitively for your specific numbers, and "too small to be worth it" is a possible written answer. You'd know, for free, instead of wondering.
Can you work claims we already wrote off?
Often, yes: a write-off in your PM system is an accounting entry, not a legal surrender. If deadlines haven't fully expired or an exception basis exists, written-off claims fall in our 365+ contingency tier: 30% of what's recovered, nothing if nothing posts. The audit tells you which of your write-offs are actually still alive.
What can't you recover?
Three things, and we say so up front: claims past every timely-filing and appeal deadline with no exception basis, claims with no supporting documentation and no way to reconstruct it, and true contractual adjustments your contract genuinely requires. If most of your AR falls in those buckets, the audit says so and you keep the analysis; that candor is the product.
Do you handle prior authorizations for us going forward?
We're a recovery and prevention service, not front-office staffing; we don't sit in your auth queue. What we do instead is show you, monthly, exactly which auth-workflow gaps are causing denials and what to change, which for most practices eliminates the majority of auth denials at the source. Recovering the auth denials you already have? That we do.
Didn't find your question?
15 minutes, a real person, no pitch deck. Or skip the call and sign up online. Prefer to dial? (479) 274-0716
Know your number before you sign anything.
The Recovery Audit is a $500 analysis, yours free, in writing, with an honest go/no-go. Limited slots each month.