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2026 BEST IN KLAS
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Underpayment Recovery Services 2024
Which Firms Drive Value in Both Recovery & Prevention?
Author
Mollie Hunt
Author
Alex McIntosh
Author
Shawn Howell
Amid continuing financial pressures to increase revenue with fewer resources, many provider organizations look to firms that can not only recover underpayments but also help improve internal processes to prevent future revenue leakage. Since the 2022 report on underpayment recovery services, KLAS has broken out a denials management services market segment (reported on earlier this year); now, underpayment recovery services include charge capture, transfer DRG, DRG validation, and zero-balance review. Additionally, there have been several acquisitions that have affected the market (i.e., the R1 RCM acquisition of Cloudmed, the FinThrive acquisition of TransUnion Healthcare). This report explores what service lines organizations use firms for, how well firms provide actionable insights, how firms help organizations prevent future revenue leakage, and what factors drive firm selection across the market.
Customers Use R1 RCM Widely across Service Lines, See Firm as a Strong Partner
With mostly large validated client organizations (over 1,000 beds), R1 RCM—Best in KLAS 2024 winner for underpayment recovery services—is the only measured firm with over 50% of respondents using the firm across all service lines. The majority of R1 respondents are highly satisfied with the services, often specifically pointing to the strength of R1’s DRG validation and underlying technology to support their services. Respondents say R1 is a partner with responsive support personnel, who are seen as well trained, dedicated to problem-solving and meeting clients’ needs, providing strong work, and able to integrate well with internal teams. That said, several respondents mention that insufficient knowledge transfer following staff turnover has negatively impacted the stability of their R1 engagements. Many respondents appreciate the firm’s guidance (e.g., root-cause analyses, application of algorithms), which allows customers to fix errors and improve internal processes. The firm’s reports provide rich information and are especially helpful in internal leadership conversations. Two respondents say they have occasionally disagreed with the firm’s recommendations or felt they were incorrect; these clients would like reports with increased transparency and details to help them better understand the firm’s guidance.
BESLER Seen as an Expert in Transfer DRG, Provides an Easy Engagement for Customers
Interviewed customers view BESLER as the industry expert on Medicare and transfer DRG. Respondents most commonly use BESLER for transfer DRG; a small percentage use the firm for DRG validation. A few customers are expanding their engagement with the firm, through either increased project scope or increased facilities. Responding organizations often highlight BESLER’s engagements as easy, saying the firm takes full ownership of projects and goes above and beyond to chase opportunities in underpaid areas. When respondents ask questions, they are met with quick responses that showcase BESLER’s expertise. Respondents highlight the firm’s reports, which provide a variety of data points in detail, such as what is being worked on, statistics, and recommendations with backup CMS information. After sending reports, BESLER discusses all aspects with respondents, and as a result, they usually trust BESLER’s work and recommendations. Additionally, respondents feel the firm presents guidance in a way that is accessible and not pushy. Generally, respondents find the services to be valuable, though a couple mention the expense. Two interviewed clients desire more forward-looking engagements, saying they want BESLER to expand into other service lines (e.g., APR-DRG) or come up with new initiatives.
Revecore Customers Highlight Responsive Support; Some Seeking More Actionable Insights
Among firms in this report, Revecore has the highest percentage of respondents utilizing the firm for zero-balance review. Most interviewed clients are highly satisfied with the firm and feel Revecore excels at finding missing revenue and ensuring nothing is left on the table. Respondents highlight good relationships and communication, noting that their individual support contacts are responsive and supportive. The firm’s tips and guidance for creating better internal processes (e.g., data trends) are appreciated, helping clients correct coding errors. Additionally, most clients feel the firm helps them work better with payers by providing best practices from the market. Four interviewed organizations want the firm to be more innovative in and analytical when finding more payment opportunities. Additionally, these respondents want Revecore to improve their reporting by adding more details and actionable insights on how to better influence payer behaviors. Although most clients report supportive and engaged contacts, multiple respondents from two organizations are very dissatisfied, pointing to changes in management and structure; they feel that their voices haven’t been heard and that the partnership has declined, and they want more clarity on the management’s direction.
FinThrive* Rated High for Delivering Outcomes
Almost all interviewed FinThrive* clients are highly satisfied with the firm’s underpayment recovery services, especially their ability to deliver outcomes. Several respondents mention that the highly automated process doesn’t require much from their internal staff and that the firm quickly responds to questions. Three respondents say the firm could improve their tools, though generally, respondents feel FinThrive is doing well and should continue improving technology and delivering outcomes.
*Limited data
Across Market, Value Is Most Top of Mind when Choosing Firm
Due to the nature of the underpayment recovery business (finding missed revenue), provider organizations prioritize the value they receive from these services—they want competitive pricing and a strong understanding of contingency rates and fees. Beyond cost, provider organizations most mention wanting to fully understand expected outcomes and see a track record of demonstrated expertise backed by solid methodology, often seen through past success rates or pilot programs. Guidance is also a top factor—respondents want to be able to prevent future revenue leakage through identified opportunities and root-cause analyses.
Voice of Highly Satisfied Clients
“Working with BESLER has significantly transformed our healthcare institution’s approach to managing underpayments and optimizing our DRG processes. Their expertise and services have elevated our operational efficiency to a very high level. This achievement underscores the substantial progress we have made, which is largely attributable to the meticulous and targeted support provided by BESLER.” —Manager
“I get reports on the returns we get, and we have been very happy with the dollars that FinThrive has found and returned. We have a pretty clear understanding of what FinThrive will and will not charge us for. The return has been fantastic with this service for what we pay. We have had FinThrive around for a while, and we have been consistently happy with the results. . . . FinThrive really is fairly hands-on, and our team members don’t have to put in a lot of time to support this effort. We are happy with FinThrive’s results, and we are pleased with the work they are doing.” —Director
“ R1 is a role model for partnerships in all aspects, including engagement, reports, and professionalism. The firm helps us be self-reliant. They help us to not rely on them forever, so they are really trying to work themselves out of business. We don’t see that every day. The firm provides us with trends so that we can implement things, and that reduces the firm’s opportunities. But then the firm continues to find more to do, and that is why we really value them. The firm doesn’t just continue to produce the same wins. They allow us to improve our systems and get smarter, and then they just keep digging.” —Director
“ Revecore doesn’t just come in, try to collect money, and walk away. They meet with us frequently and help us get better. Working with Revecore is a partnership and is unlike other firm relationships where we are just buying a service. Our relationship with Revecore is very interactive, and it is continuously improving. They are very good at helping us identify opportunities to improve our internal processes. When they find an opportunity, they come back to us with recommendations on how to fix things upstream, and that is very helpful. By doing that, the firm works themselves out of a job over time. We end up collecting the money instead of paying them a fee to collect it.” —Director
How Do Provider Organizations Define “Innovative” for Underpayment Recovery Services?
KLAS asked interviewed provider organizations whether they feel their firm is innovative and why. In these discussions, three trends emerged as to what being innovative means in this market:
- Expertise: Respondents feel it is crucial for their firm to have the right level of expertise. Firms need to be able to conduct the service while continually updating their knowledge base around CMS regulations and Medicare products.
- Underlying technology: Advanced technology can help firms take ownership in their work and reduce the burden on their clients to feed data to the firms. One provider organization noted they want their firm to utilize AI.
- Continuous improvement: Provider organizations want their firms to keep improving their methodology and algorithms to drive increased future revenue recovery.
About This Report
Each year, KLAS interviews thousands of healthcare professionals about the IT solutions and services their organizations use. For this report, interviews were conducted over the last 12 months using KLAS’ standard quantitative evaluation for healthcare services, which is composed of 9 numeric ratings questions and 3 yes/no questions, all weighted equally. Combined, the ratings for these questions make up the overall performance score, which is measured on a 100-point scale. The questions are organized into five client experience pillars—loyalty, operations, relationship, services, and value.
In addition to the standard evaluation, KLAS asked the following supplementary questions specific to the underpayment recovery services market:
- When your organization is selecting an underpayment recovery services firm, what is the primary factor that drives the decision-making process?
- How well does your firm’s reporting meet your needs?
- How well does your firm identify opportunities to improve your internal processes?
- How innovative do you feel your firm is in the services they provide?
Sample Sizes
Unless otherwise noted, sample sizes displayed throughout this report (e.g., n=16) represent the total number of unique client organizations interviewed for a given firm or service. However, it should be noted that to allow for the representation of differing perspectives within any one client organization, samples may include surveys from different individuals at the same organization. The following table shows the total number of unique organizations interviewed for each firm or service as well as the total number of individual respondents.
Some respondents choose not to answer particular questions, meaning the sample size for any given firm or service can change from question to question. When the number of unique organization responses for a particular question is less than 10, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 5, no score is shown. Where textual content relies on limited data, the firm name is marked with an asterisk. Note that when a firm has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.
Writer
Carlisa Cramer
Designer
Kath Spencer
Project Manager
Sydney Toomer
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2026 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.