Hospital Denial Appeals
Appeals and payment recovery for hospitals and health systems on denied and underpaid claims, including contingency engagements when the goal is the recovery.
Rivet Health Law represents hospitals and health systems on hospital revenue recovery and insurance denial appeals. The work is the denied claim, the underpaid claim, and the money a payor still owes after the remittance.
Reviewed by Joseph Rivet · October 15, 2026
The Challenge
A denial and an underpayment are different files
A denial refuses the claim. An underpayment pays something, just not the amount the contract, the statute, or the fee schedule supports. Both can be appealed. The deadline, the record, and the remedy are often different, so they should not be written as the same letter.
Underpayment and downcode recovery
Contract rate and fee-schedule disputes
Medical-necessity and documentation appeals
No Surprises Act disputes where the firm represents the hospital or health system
Contingency engagements when the point of the work is the recovery
Who We Help
Who this work is for
Joseph Rivet spent more than 20 years in coding, billing, compliance, and reimbursement, including hospital and clinic operations and work on the payer side, before practicing law. A hospital appeal starts from the payment method and the record, not from a generic demand letter. The firm does not publish settlement amounts or recovery totals.
- Hospitals and health systems appealing denied or underpaid claims
- Revenue cycle teams facing a department-wide pattern rather than one account
- Critical access hospitals whose appeals were written in prospective-payment language
- Billing companies whose hospital client still owns the appeal and the recoupment
Our Process
First steps you can take today
These steps organize the file. They are not a substitute for counsel.
- 1
Pull the denial or the remittance and write down the appeal deadline.
- 2
Separate one clinical denial from a pattern of underpayments.
- 3
Name the payment method: contract rate, prospective payment, emergency-service standard, or critical access cost-based payment.
- 4
Decide whether the goal is the money back. That is the question that decides whether a contingency fee fits.
A denial and an underpayment are different files
A denial refuses the claim. An underpayment pays something, just not the amount the contract, the statute, or the fee schedule supports. Both can be appealed. The deadline, the record, and the remedy are often different, so they should not be written as the same letter.
For a hospital, the useful split is clinical versus financial. One chart that fails medical necessity is not the same matter as a service line paid below the contract rate.
Name the payment method before the argument
A prospective-payment hospital, a contract rate, an out-of-network emergency standard, and a critical access hospital are not interchangeable. Medicare pays critical access hospital inpatient services on a reasonable-cost basis. Outpatient payment depends on the method the hospital elected. An appeal written in the wrong method misses the rule that actually sets the number.
Commercial plans follow the contract unless the contract adopts another standard. The chargemaster is not that standard.
How the fee is set
When the work is getting a denied or underpaid claim paid, the firm can take the matter on a contingency fee: the fee depends on a successful recovery. The percentage is agreed before the work starts. Rivet Health Law does not publish a standard percentage, and a range advertised by another firm is not this firm’s fee.
A defined review, a policy, or ongoing counsel is more often a flat fee or a subscription. The pricing page names those models. If a contingency does not fit the file, the firm will say so before anyone is engaged.
Common questions
- Does Rivet Health Law appeal denied and underpaid claims for hospitals?
- Yes. The firm represents hospitals and health systems on insurance denial appeals and on recovery of underpaid claims. A single account and a department-wide payment pattern are scoped as different matters.
- How does the firm charge a hospital for claim appeals and payment recovery?
- When the point of the work is the recovery, the firm can use a contingency fee tied to what is recovered. The percentage is agreed before the work starts. The firm does not publish a standard contingency percentage. Other matters are priced as a flat fee or a monthly subscription.
- Will the firm publish case results or a typical recovery?
- No. Settlement amounts and recovery totals are not published on this site. A comparison that depends on another firm’s advertised percentage is not a quote from Rivet Health Law.
- What should a hospital send before the first call?
- The denial or underpayment notice, the appeal deadline, the remittance, the contract or payment standard, and one chart that matches the claim. A pattern needs a short sample, not the whole department.
800 E. Ellis Road, Ste 515, Norton Shores, MI 49441
(231) 799-4870
rivethealthlaw.com
Before the appeal
6 itemsWhat to gather
These are the pieces that decide whether a denial or an underpayment can still be pursued. They are not a promise of recovery.
Check items off as you collect them. Your progress is saved on this device.
This sheet is a gather list for your own file. It is not legal advice.
Industries
This page is educational. It is not legal advice and does not create an attorney-client relationship. Facts, contracts, and appeal windows control the next step.