Orthopedic Underpayments in 2026: How Everest A/R Management Group Recovers Hidden Revenue

Paid Claims Are Still Costing Orthopedic Practices Millions

In 2026, orthopedic practices are facing a silent but growing revenue threat: underpaid claims. Unlike denials, underpayments don’t land in rejection queues or denial worklists. They post as “paid” — but not paid correctly.

Across joint replacements, fracture care, arthroscopy, and sports medicine procedures, commercial payers are reimbursing less than contracted rates, often without explanation. Many practices never discover the loss.

At Everest A/R Management Group, orthopedic underpayment recovery has become one of the highest ROI revenue cycle strategies for practices nationwide.

What Is Driving Orthopedic Underpayments in 2026?

Underpayments are no longer isolated payer errors. They are systemic.

Aggressive Payer Cost-Containment

Payers are applying:

• Automated fee schedule reductions

• Incorrect multiple procedure payment reductions (MPPR)

• Improper bundling logic

Complex Orthopedic Coding Structures

Orthopedics involves:

• High RVU procedures

• Implants and device-related costs

• Modifier-dependent reimbursement

A single missing or misapplied modifier can reduce payment by 20–50%.

Contract Misalignment

Many practices:

• Don’t have payer contracts loaded accurately

• Aren’t monitoring annual rate updates

• Don’t compare paid vs contracted amounts

High-Risk Orthopedic CPT Codes for Underpayments

Everest A/R routinely identifies underpayments on these high-value orthopedic procedures:

CPT Code Procedure

27447 Total Knee Arthroplasty

27130 Total Hip Arthroplasty

29827 Arthroscopic Rotator Cuff Repair

29881 Knee Meniscectomy

27506 Femur Fracture Repair

20610 Large Joint Injection

These procedures often show partial payment errors, not outright denials.

Why Most Orthopedic Practices Never Catch Underpayments

No Post-Payment Audits

Once a claim posts as “paid,” most billing teams move on.

Limited Staff Bandwidth

In-house teams prioritize:

• Denials

• Aged AR

• Prior authorizations

Underpayment review is time-intensive and often skipped.

No Contract Modeling

Without automated contract comparison tools, it’s nearly impossible to identify payment discrepancies at scale.

How Everest A/R Management Group Identifies Hidden Underpayments

Step 1: Contracted Rate Benchmarking

Everest A/R loads payer contracts into advanced analytics tools to compare:

• Allowed amount

• Paid amount

• Contracted amount

Step 2: Line-Level Payment Analysis

We review:

• Modifier impact (-26, -50, -59, -LT, -RT)

• MPPR reductions

• Incorrect bundling

Step 3: Post-Payment Audits

Our team audits:

• “Paid in full” claims

• Claims with unexplained payment reductions

• Repeat payer underpayment patterns

Everest A/R’s Orthopedic Underpayment Recovery Process

Root-Cause Identification

We determine whether the underpayment is caused by:

• Contract misinterpretation

• Coding logic

• Modifier application

• Payer system error

Targeted Appeals

Our appeals include:

• Contract language references

• CPT and modifier justification

• Payment variance calculations

Persistent Payer Follow-Up

Everest A/R does not rely on one-time appeals. We:

• Track appeal timelines

• Escalate unresolved cases

• Refile when necessary

Continuous Monitoring

Recovered underpayments inform:

• Future claim edits

• Coding workflows

• Payer negotiation strategies

Real Impact: What Orthopedic Practices Recover

Orthopedic practices working with Everest A/R typically see:

• 8–15% increase in net collections

• Reduced AR days

• Improved cash flow predictability

• Lower payer dependency risk

Underpayment recovery often generates six-figure annual revenue gains without increasing patient volume.

Why Orthopedic Practices Choose Everest A/R Management Group

✔ Specialty-trained orthopedic billing experts
✔ Advanced contract and payment analytics
✔ Proven appeal success with commercial payers
✔ End-to-end RCM support
✔ Transparent reporting and recovery tracking

In 2026, orthopedic billing success is not just about clean claims — it’s about accurate reimbursement.

Conclusion: Stop Accepting Incorrect Payments as Final

If your orthopedic practice is only managing denials, you are leaving substantial revenue on the table.

Everest A/R Management Group helps orthopedic practices uncover, recover, and prevent underpayments — turning missed revenue into measurable growth.