How incremental recovery is calculated.

Follow the same claim from determination to payment.

A payment determination, additional cash received, and the amount the practice retains after costs answer different questions. Record each separately and use the same claim or service scope when comparing amounts.

• Determination: the payment amount selected in the dispute. Confirm how the initial payment and patient cost sharing affect the additional payer amount due.
• Incremental cash received: cumulative payer receipts above the original payment, reconciled for corrections, refunds, and recoupments through a stated date.
• Net incremental cash retained: incremental cash received less PRP fees and other pursuit costs borne by the practice, accounting for any fee refunds.

Keep unpaid and partially paid matters visible. A favorable determination should not be counted as collected cash before payment is received.

Ask for a report you can reconcile.

When reviewing an IDR partner’s reporting, look for the pathway, current stage, next action and owner, controlling deadline, original payment, determination or settlement, subsequent receipts, outstanding balance, and costs. Ask how each amount can be traced to a remittance or payment record.

PRP provides claim-level visibility into status, deadlines, actions, outcomes, and recovery. Confirm the reporting fields, payment-follow-up responsibilities, and reconciliation process during commercial review.

Compare results from a defined group of matters.

Ask which matters are included, how many there are, when they entered the process, and the date through which outcomes were observed. Separate federal and state pathways and identify the specialty and claim mix.

• Distinguish claims, disputed line items, and batched disputes before comparing volume or win rates.
• Ask whether a recovery median includes zero recoveries or only successful matters.
• Request open, ineligible, withdrawn, lost, and unpaid counts alongside completed outcomes.
• For collection rates, distinguish the share of matters fully paid from the share of additional dollars due actually received.
• For time to payment, identify the start and end events and the matters still awaiting cash.

These are evaluation questions, not published PRP performance results. Any example on this page is illustrative.

Confirm the commercial terms in writing.

The formula explains the recovery base in plain language. The applicable contingent percentage, claim-value and volume minimums, invoicing timing, treatment of fees and expenses, and handling of an unpaid determination are confirmed in the commercial review and written services agreement.

A determination and money actually received are not always the same event. The agreement—not this educational page—controls when a fee is earned and payable.

Choose the next step for an underpaid claim.

If your team is still identifying the available route, start with our underpaid out-of-network claims guide. For an issued determination, review payment follow-up and reconciliation.