The Challenge
A five-facility radiology group processing thousands of claims monthly couldn't confidently answer: "Are we actually getting paid for everything we billed?"
Payment reconciliation was done manually — a slow, error-prone process leaving significant revenue gaps undetected. Leadership suspected money was slipping through the cracks but had no way to quantify how much or where.
The core problem: With 31,000+ claims per billing cycle, manual reconciliation meant auditors could only spot-check a fraction of records — leaving most discrepancies invisible.
The Approach
Automated RCM deployed an AI-powered billing reconciliation analysis across all 31,863 claims — every single record, not a sample.
Data Ingestion & Cleaning
Billing records were consolidated, standardized, and deduplicated into a single source of truth.
AI-Powered Claim Matching
Every billed claim was matched against payment records using intelligent reconciliation logic.
Zero-Pay & Underpayment Analysis
Claims with zero payment were isolated and categorized by reason: denial, no response, payer error, or billing issue.
Actionable Report Delivery
Results delivered in a structured report, prioritized by dollar value and recovery likelihood.
What We Found
Key insight: The $89K in zero-pay claims wasn't due to billing errors — it was payer non-response that manual processes failed to flag. AI surfaced every unpaid claim automatically.
The Results
- Full billing visibility — Leadership gained a complete, reconciled view of all claims and payments for the first time.
- Prioritized recovery roadmap — The $89K in zero-pay claims was organized by dollar value for immediate follow-up.
- Process improvement insight — Analysis revealed which payers and claim types had the highest non-payment rates.
- Repeatable audit framework — A reusable AI audit process now runs on future billing cycles without starting from scratch.
"We had no idea how much was slipping through until the AI analysis put every claim under a microscope. The findings paid for the audit many times over."
— Billing Director, 5-Facility Radiology Group (name withheld for confidentiality)Is This Happening at Your Practice?
Zero-pay claims and unreconciled billing records show up across surgical centers, urgent care groups, and any multi-provider practice relying on manual reconciliation.
- Do you know your current clean claim rate?
- Can you see every zero-pay claim from the last 90 days?
- Is your team manually reconciling thousands of records?
If the answer is "no" or "not easily," there's likely uncollected revenue in your billing data right now.
Find Out What's in Your Billing Data
Book a free 30-minute discovery call. We'll discuss your current billing process and whether an AI audit makes sense for your practice.
Book Your Free Discovery Call No commitment required. Or visit getautomatedrcm.com to learn more.