Recoupments — also known as takebacks or chargebacks — cost healthcare providers more than $1.6 billion every month.
Yet despite the staggering financial impact, recoupments in healthcare remain a largely misunderstood, under-discussed, and poorly addressed challenge in the healthcare revenue cycle.
Recently, healthcare leaders from SCA Health and Cleveland Clinic discussed the pain points of recoupments at Waystar True North™ during a panel discussion.
In this Q+A, we explore the challenges of recoupment in healthcare for both ambulatory practices and health systems — and how experts plan to tackle them.
What are recoupments in healthcare payments?
“A recoupment is basically just a delayed denial,” says Renee Miller, VP of Product Management at Waystar. “It’s something that’s already been paid, but now the payer is auditing, and they’ve decided not to pay.
“It could be up to seven years old, and providers have to be able to find that original payment and tie that back to the original claim. How do you go about doing that when it happens all the time?”
Q+A: Cleveland Clinic + SCA Health
1. How are healthcare organizations managing recoupments today?
Joel Woods: It has become a forever project. We’re throwing everything at it — advanced SQL, automation — and it’s still growing. We had nearly $1B in offset activity last year. A lot offsets, but the volume is overwhelming.
Terri Kirby: It’s manual and inconsistent. Every payer does it differently. If it’s a balance that hangs around for months, someone with tribal knowledge has to handle it — and if they leave or miss it, it gets lost. You can’t trend or track it.
2. What trends are you seeing for recoupments in healthcare?
Terri Kirby: Teams still rely on manual spreadsheets.
We need visibility into:
- What caused the recoupment?
- What happened after?
- Did we fix it?
- And did we recover the money?
Joel Woods: If the knowledge isn’t documented, the next person starts over — calling the payer again or repeating work. Accounts can be touched six times for the same issue.
3. What are the biggest barriers to managing PLBs, takebacks + recoupments in healthcare?
Joel Woods: The goalposts keep moving. Payer documentation changes — or doesn’t exist. Even when payers agree something’s wrong, the tech doesn’t support the fix.
Terri Kirby: Right when we learn the rules, the rules change— and no two payers do it the same. Staff say they spend most of their day chasing recoups, but we can’t quantify it.
4. Can you report the financial impact of recoupments in healthcare today?
Joel Woods: We’re carrying huge credits and debits and must explain them monthly. We may have $20 million on the books, and leadership asks, ‘What’s happening?’ It’s painful to justify without clarity.
Terri Kirby: Without reliable reporting, it’s hard to tell the story. Explaining to a CEO why $5,000 disappeared — after it was already paid — makes no sense to them.
5. Can you share a real-world healthcare recoupment experience?
Terri Kirby: We saw a $200K recoupment that dragged on for 18 months. The payer took it back in small amounts, with the remit number changing every time. Tracking it manually was nearly impossible.
Join the conversation on recoupments in healthcare
Recoupments may be one of the costliest, least understood issues in the healthcare revenue cycle — but they shouldn’t remain in the shadows.
Tune into our on-demand webinar where we break down everything leaders need to know about recoupments, from key terms and payer audits to tips for improving visibility and automation.
