Sample report · illustrative figures

Denial & underpayment audit

Leakage Report Card

Example practice: ~$2.0M annual billings, 14 BCBAs
Window reviewed: 90 days of submitted claims · 1,180 claim lines
Payers: 2 commercial, 1 state Medicaid

Denied or underpaid
$76,800
15% of claims in the window, sitting unworked
Recoverable
$46,000
Procedural denials still inside their windows
Annualized recoverable
~$184K
If this 90-day pattern holds across the year
$46,000 recoverable $30,800 not recoverable (past timely filing, non-covered)
Estimate yoursDrag to size it to your practice
Est. annual recoverable
$184,000

Rough estimate at industry-typical denial and recovery rates. A real Mend audit uses your actual claims, not an average, so your number will differ. No system access needed to run it.

Where the money is

The $76,800, line by line

Every denial bucketed by root cause, with what it would take to win it back. We show the dead ones too, because pretending everything is recoverable is how you lose trust.

Recoverable·$46,000
Authorization exhausted, 97153 units past approved
Sessions billed beyond the approved unit cap. Retro-auth request plus corrected claims.
$15,600
Recoverable
Unit and 8-minute rounding errors
Time-based codes rounded against the practice. Recalculated units, corrected claim resubmission.
$8,900
Recoverable
Missing or wrong modifier
Rendering-provider and HO/HN modifiers absent or mismatched to the credential. Corrected claim.
$7,800
Recoverable
Concurrent 97155 and 97153 overlap
Supervision billed against direct therapy, caught by an NCCI edit. Documentation plus appeal.
$6,100
Recoverable
Coordination of benefits not updated
Secondary payer on file out of date. COB correction and resubmission to the right payer.
$4,200
Recoverable
Duplicate denial on distinct sessions
Two real sessions flagged as a duplicate. Appeal with session logs and timestamps.
$3,400
Recoverable
Not recoverable·$30,800
Past the timely-filing window
No exception path left with these payers. Lost, and a reason to never let it happen again.
$17,900
Dead
Non-covered service or plan exclusion
The plan does not cover the service. Nothing to appeal.
$8,500
Dead
Patient ineligible on date of service
Coverage lapsed at the time of service. Not collectible from the payer.
$4,400
Dead
What recovery actually looks like

Of the $46,000 recoverable, applying realistic payer win rates on appeals and corrected claims, roughly $36,800 is likely to come back, the bulk of it within 30 to 90 days as appeals clear their windows. The $30,800 that is dead stays dead, but most of it traces to two fixable habits, late filing and stale eligibility, that we flag so next quarter's leakage shrinks at the source.

What happens next

You see this before you commit anything

This report is the free part. It runs off an exported claims file you send us, under a signed BAA. No login to your system, no access to your portals, no commitment. You see exactly what you are owed first.

Then you decide. If you want us to recover it, we rework and appeal the claims worth fighting, you keep what comes back, and you only pay a share of what we actually recover. If we recover nothing, you owe nothing. The keys to your systems only come into it after you have already seen us find money.

Free audit No system access to start Signed BAA Pay only on recovery

This is a sample report with illustrative figures for a hypothetical practice. It is not a real client result. The denial categories and recovery logic reflect how ABA claims actually fail and get reworked; the dollar amounts are examples. Denial-rate and recovery-rate ranges are drawn from published behavioral-health industry data. A real Mend audit uses your own claims.

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