Reimbursement calculator
Underpayment Calculator
Underpayments are the quiet leak: the claim shows as paid, so nobody looks at it again, while the payer paid less than your contract allows. This calculator sizes the gap from one claim pattern: what the allowed amount.
What this calculator shows
Underpayments are the quiet leak: the claim shows as paid, so nobody looks at it again, while the payer paid less than your contract allows. This calculator sizes the gap from one claim pattern: what the allowed amount should have been, what actually arrived, and how many claims it happened on.
Get the expected figure from your contract or fee schedule, and the actual figure from the remittance for the same code and payer.
Reimbursement calculator
Underpayment Calculator
Paid, but paid less than the contract says? Size the gap.
How the calculation works
Underpayment per claim = expected allowed - actual payment, floored at zero. Total exposure = per-claim underpayment x affected claims. If the actual payment meets or beats the expected amount, this claim pattern shows no underpayment.
How to read your result
One shorted claim is a payer error; fifty identical ones are a pattern worth an appeal batch and a contract conversation. Actual contracts and claim-specific adjudication decide what is truly owed, including bundling and modifier rules, so verify a sample by hand before escalating. Catching these is the work of underpayment recovery, and the rate at which they happen feeds the revenue leak calculator.
Looking for another measure? See all medical billing calculators or the formulas collected in our medical billing KPIs guide.
Before you rely on the number
Results are estimates for educational and operational planning, built from the figures you enter. They are not guarantees of reimbursement, savings or recovery, and they do not replace a review of your own claims, contracts and remittances. Do not enter patient-identifiable or protected health information: this calculator runs in your browser and nothing you type is stored or sent anywhere.
FAQ
Calculator questions
Still have a question? Talk to our team about your billing workflow.
How do I know my expected allowed amount?
From your payer contract's fee schedule for that code, or from what the same payer paid correctly on earlier claims. If neither is handy, that gap in your records is worth fixing first.
Can an underpayment be correct?
Yes. Bundling, multiple-procedure reductions and modifier rules can legitimately lower payment. The calculator flags the difference; your contract decides whether it is owed.
What do I do with a total exposure figure?
Appeal in batches with the contract language attached, inside appeal deadlines. Patterns reported with claim lists get payer attention that single calls do not.
Want this run on your real claims?
A free billing assessment reviews your actual denials, A/R and contracts, then gives you these numbers from your own data, in writing, before you decide anything.