Published by HFMA Oregon Chapter, May 2026 | Author: Liana Hamilton, President, Payment Variance Aspirion
The Silent Revenue Drain
Underpaid claims don’t behave like denials—they don’t create tasks, alerts, or follow-up workflows. The shortfall settles into a zero-balance account, and the case closes. In 2023, hospitals absorbed $130 billion in Medicare and Medicaid underpayments, with Medicare reimbursing just 83 cents per dollar of care delivered. Commercial payers compound the exposure further, with HFMA estimating contract underpayments can reach as high as 11% of net patient revenue. With hundreds of dense payer agreements to manage, most teams simply don’t have the bandwidth to go back and look.
Where AI Changes the Equation
AI-powered contract modeling uses large language models to ingest managed care contracts at scale, extracting payment rules across hundreds of agreements simultaneously and building accurate pricing models that reflect what a hospital is genuinely owed. Unlike legacy contract management tools, AI platforms maintain living databases updated in real time—not static repositories requiring manual updates every time a contract changes. Applied to zero-balance accounts, the technology examines closed claims at volume and identifies entire categories of systematic underpayments that manual review would never surface. Aspirion’s client data shows 79% of underpayment recoveries exceed $1,000, with the most common range falling between $1,001 and $2,500.
Scale, Speed, and the Right Expertise
Closed accounts aren’t settled accounts—they’re overlooked ones. The revenue sitting in zero-balance accounts was already earned, already documented, and in most cases already contractually guaranteed. Aspirion’s ContractIQ platform pairs LLMs that parse managed care contracts with U.S.-based attorneys and clinicians who validate every finding before action is taken — delivering the scale of AI with the judgment of experienced professionals.
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