Balance billing mediation
When a state rule or the No Surprises Act, not the chargemaster, sets what the patient can be billed.
ReadReimbursement
Disputes, settlements, and payor adjudication for government and commercial claims.
A paid claim is not always a correctly paid claim. Rivet Health Law works the gap between what the record supports and what the payor actually issued—government and commercial—without treating the remittance as the last word.
Reviewed by Joseph Rivet · September 29, 2026
The Challenge
Where money usually leaks
Most underpayments are not dramatic denials. They are a reduced allowed amount, a downcoded E/M, a modifier the system ignored, or a fee schedule the plan updated without telling the group.
Payor reimbursement disputes and settlements
A short payment or a settlement, when the remittance is not the last word.
Learn moreIncorrectly adjudicated claims
A reduced allowed amount or a downcode that does not match the note.
ReadTelehealth reimbursement
What Medicare and a commercial plan will pay when the visit was not in the office.
ReadProposed and final rules that affect payment
A proposed rule for planning, and a final rule before anyone changes how the claim is built.
ExploreState laws and reimbursement policies
When a state statute, not the plan’s manual, decides the next step.
ReadReimbursement analysis for new services, procedures, and medical devices
Coverage and coding mapped once, before the first claim goes out.
Read
Who We Help
Who this work is for
Joseph Rivet spent more than 20 years inside healthcare operations, coding, billing, and reimbursement before practicing law. The reimbursement work starts from how a claim is built, not only from how a statute reads.
- Hospitals and health systems reviewing underpayments
- Physician groups seeing silent policy changes on the remittance
- Practices adding a new service, site, or device
- Providers caught between state balance-billing rules and a payor contract
Our Process
First steps you can take today
These steps organize the file. They are not a substitute for counsel.
- 1
Pull five recent remittances that feel short and note the reason codes.
- 2
Match each one to the note, the codes billed, and the contract or CMS schedule.
- 3
Write down whether the shortfall is a denial, a downcode, or a reduced allowed amount.
- 4
If no-shows or late cancellations are part of the leak, run the recovery calculator below before changing policy.
Where money usually leaks
Most underpayments are not dramatic denials. They are a reduced allowed amount, a downcoded E/M, a modifier the system ignored, or a fee schedule the plan updated without telling the group.
Before anyone drafts a demand letter, it helps to stack the remittance, the contract or CMS fee schedule, and the documentation that was in the chart that day. The story is usually in that stack.
What a careful review looks like
The firm looks at how the claim was built—codes, modifiers, place of service, and any later rebilling—then at the payor’s stated reason. If the reason does not match the record, that mismatch is the case.
New services and devices need the same discipline before the first claim goes out. It is cheaper to map coverage and coding once than to unwind a year of preventable denials.
Common questions
- Is an underpayment the same as a denial?
- No. A denial refuses the claim. An underpayment pays something, just not what the record and the contract support. Both can be appealed, but the evidence and the deadline are often different.
- How quickly should a reimbursement issue be raised?
- Contract and CMS appeal windows are short. If the remittance is more than a few weeks old, check the timely-filing and appeal language before gathering a larger sample.
- Can a practice recover no-show revenue?
- Sometimes, if the policy is clear, the patient agreed to it, and the payor does not prohibit the charge. The calculator on this page estimates the dollars at stake. It is not a green light to bill.
Working tool
60-second estimateSee what no-shows may be costing the practice
A 60-second estimate of annual lost appointments and recoverable revenue. Use it to decide whether a no-show policy is worth the compliance work—not as a promise of recovery.
When you want help
Bring the letter, the remittance, or the agreement.
If the first steps on this page raised a question, the firm can sit with the file.
This page is educational. It is not legal advice and does not create an attorney-client relationship. Facts, contracts, and appeal windows control the next step.