Published by HFMA Massachusetts – Rhode Island Chapter, May 2026 | Author: Liana Hamilton, President, Payment Variance Aspirion
The Underpayment Gap Nobody Is Chasing
Underpaid claims don’t create tasks—they create zero-balance accounts that close quietly and stay that way. Hospitals absorbed $130 billion in underpayments from Medicare and Medicaid in 2023, with shortfalls growing 14% annually. Commercial payers compound the problem: HFMA estimates contract underpayments can consume as much as 11% of net patient revenue. With hundreds of payer agreements to manage, most teams simply don’t have the bandwidth to go back and look.
How AI Contract Modeling Changes the Equation
AI-powered contract modeling ingests managed care contracts at scale, extracting payment rules and comparing closed accounts against actual contract terms to surface entire classes of systematic underpayments. Unlike static contract management tools, AI platforms maintain living databases updated in real time. Aspirion’s client data shows 79% of underpayment recoveries exceed $1,000—opportunities that variance reports and manual review would never reach.
The Bottom Line
Zero-balance accounts are not final answers—they are overlooked ones. For revenue cycle leaders operating on thin margins, the revenue sitting in closed accounts was already earned, already documented, and in most cases already contractually guaranteed. Pairing AI-driven contract analysis with clinical and legal expertise is the only approach with the scale to recover it.
Read the full article here.