Procedure-level Medicare records processed in this demonstration
Aggregate payment variance identified across three specialties
Specialties analyzed: Cardiology, Ophthalmology, Gastroenterology
884,901 records processed. $4,052,046,527 in payment variance identified. Across three specialties. One engine.
FORT processed 884,901 procedure-level Medicare records across cardiology, ophthalmology, and gastroenterology. This page presents the methodology, findings, and procedure-level data from that analysis.
884,901 records processed. $4,052,046,527 in payment variance identified. Across three specialties. One engine.
A team of experienced billing analysts reviewing 884,901 records manually would require an estimated 18 to 24 months working full time. FORT completed the same analysis in a single session.
This demonstration applies FORT Pass 3 remittance drift reconciliation to federal Medicare data. In a client engagement, all four FORT passes run simultaneously across clinical delivery records, billing ledger, and payer remittance data — identifying charge capture failures, contracted rate mismatches, remittance drift, denial patterns, and timely filing risk in a single session.
Every finding is documented at the claim level and prepared for attestation under AICPA AT-C 215 by an independent CPA partner. The output is an evidentiary document, not a management report.
This analysis applies FORT's Pass 3 remittance drift reconciliation to the 2024 CMS Medicare Physician and Other Practitioners by Provider and Service dataset published at data.cms.gov. The dataset contains procedure-level payment records for physicians and other practitioners billing Medicare across the United States. This demonstration identifies payment variance between Medicare allowed amounts and actual Medicare payments at the procedure level across the selected specialty. It does not represent findings from a client engagement. Analysis date: June 14, 2026.
Total procedure-level billing records processed by FORT across this specialty.
Records where Medicare paid below the allowed amount and the claim remains within the 365-day filing window.
Aggregate dollar variance between Medicare allowed amounts and actual payments across all recoverable records.
Records where the payment gap exists but the timely filing deadline has passed, making recovery no longer actionable.
Claims classified as outside the filing window fall beyond the 365-day Medicare timely filing threshold from date of service and are excluded from the recovery roadmap.
Identifies services delivered and documented clinically but never submitted as a claim.
A cardiology provider documents a stress echocardiography. The claim is never submitted. The service is performed, the patient is treated, and zero revenue is generated.
Requires client clinical records. Not demonstrated in this public data analysis.
Identifies claims submitted below the applicable contracted rate.
A provider contract specifies $420 for CPT 93306. The claim is submitted at $380. The $40 gap per claim across 10,000 annual procedures equals $400,000 in avoidable revenue loss.
Requires client billing ledger. Not demonstrated in this public data analysis.
Identifies payments received below the Medicare allowed amount at the procedure level.
Medicare allowed $185 for CPT 93000. Medicare paid $161. The $24 gap across 50,000 annual claims equals $1,200,000 in documented underpayment.
Demonstrated in this analysis using CMS public data.
Identifies denied claims and flags recovery eligibility by payer timely filing window.
A claim for CPT 99214 is denied for missing prior authorization. FORT flags whether the denial is within the appeal window and whether the authorization requirement was contractually valid.
Requires client remittance data. Not demonstrated in this public data analysis.
| HCPCS Code↕ | Procedure Description↕ | Average Payment Gap↕ | Total Services↕ | Total Recoverable↓ |
|---|---|---|---|---|
| Q4205 | $267.89 | 4,786 | $1,282,103.95 | |
| 78431 | $441.14 | 1,665 | $734,495.16 | |
| Q4205 | $261.43 | 2,430 | $635,281.45 | |
| 37229 | $1,954.61 | 305 | $596,155.20 | |
| 99458 | $8.01 | 63,597 | $509,166.58 | |
| 78492 | $320.03 | 1,427 | $456,687.04 | |
| 99457 | $10.26 | 43,419 | $445,300.22 | |
| 37229 | $2,043.46 | 214 | $437,300.85 | |
| 78431 | $475.79 | 815 | $387,772.65 | |
| J1306 | $2.45 | 155,916 | $381,631.34 | |
| 33285 | $906.22 | 409 | $370,643.53 | |
| 78492 | $324.38 | 1,115 | $361,681.52 | |
| 78431 | $430.27 | 833 | $358,412.42 | |
| 37229 | $1,905.47 | 186 | $354,417.97 | |
| A9555 | $103.94 | 3,328 | $345,912.39 |
This analysis was conducted using publicly available data from the CMS Medicare Physician and Other Practitioners by Provider and Service dataset (2024). All figures represent aggregate payment variance across Medicare fee-for-service claims and are presented solely as a demonstration of FORT's reconciliation methodology. This analysis does not constitute a client engagement, audit finding, or CPA-attested report. CPT codes are copyright 2024 American Medical Association. All rights reserved.