Success story
Gotham Footcare
Gotham Footcare came to MedHeave with a high-risk revenue problem that it could not resolve internally.
Project Metadata
Specialty
Podiatry
City
New York
Practice size
15+ providers
Locations
Multi-location
The challenge
A large multi-location podiatry practice in New York came to MedHeave with a high-risk revenue problem that it could not resolve internally. Surgical claims were being systematically underpaid or left unpaid entirely.
A growing backlog of Verification of Benefits and authorization requests had become an operational bottleneck, straining staff and stalling cash flow.
Out-of-network negotiations had broken down, and third-party vendors were no longer sending proposals, leaving significant reimbursement on the table.
The practice’s previous setup lacked the specialized expertise to address surgical reimbursement recovery, payer-specific benefit verification, and OON negotiation strategy simultaneously.
Results
Over 1 million dollars
Total revenue recovered
Underpaid & unpaid claims
~50% of total recovered revenue
Surgical recovery share
65-85% of billed charges
OON reimbursement rate
Cleared real-time verification implemented
VOB & auth backlog
60-90 days
ongoing recoveries after
Ongoing processes rebuilt long-term
Results sustainability
What we did
Stabilized VOB & authorization workflows
Deployed experienced VOB specialists to immediately clear the accumulated backlog. Automated payer-specific benefit extraction directly from payer portals, ensuring accuracy and continuous updates. Took full ownership of authorizations for Physical Therapy, Orthotics, and surgical cases, eliminating internal staffing strain.
Rebuilt out-of-network negotiation channels
Corrected and updated the practice’s profile and contact data across all OON negotiation partners. Re-established communication channels and implemented a structured proposal intake process. Negotiations resumed promptly, consistently achieving reimbursement offers of 65%–85% of billed charges.
Recovered historical underpaid surgical claims
Took full ownership of all underpaid and unpaid surgical claims dating back to January 1, 2024. Reopened closed negotiation files, submitted targeted appeals, and aggressively followed up on unresolved balances — unlocking revenue previously considered unrecoverable.
Your patients need your attention.
Your claims need ours.
One conversation is enough to identify where your behavioral health billing is losing revenue, which claims are failing and why, and what a correctly structured billing operation looks like for your practice type.
