How to find the clinician pay that went to denied claims
Put last quarter's payroll beside what each clinician's sessions collected, and mark the sessions whose claims were denied.
Co-founder, JotPsych
You'd already paid your clinicians for last month's sessions when claims for some of those sessions came back denied.
| The session's claim | Per-session pay | A percentage of collections |
|---|---|---|
| Paid | The full rate | A share of the payment |
| Denied | The full rate | Nothing yet |
| Denied, then paid after a fix | Nothing more | A share of the payment |
An illustration of per-session pay and a percentage of collections applied to one session's claim. Under a percentage of collections, the clinician waits for the payer; under per-session pay, the practice does.
- Pull last quarter's payroll for each clinician. Write down each session, its date of service, and what you paid for it.
- Put each clinician's pay beside what that clinician's sessions collected. Use what each claim has paid so far. Ignore billed amounts. Where a clinician's pay is higher than what that clinician's sessions collected, you paid the difference from your practice's cash.
- Mark the sessions whose claims were denied. Match each denied claim to its session by clinician and date of service. Add up what you paid for those sessions. In 2023, insurers selling plans on HealthCare.gov denied 20 percent of in-network claims, the health policy group KFF found in federal data.
KFF's analysis of federal data covers only insurers selling plans on HealthCare.gov. Your own share depends on your payers, so count it from your claims.
Some denials get paid after you fix and resubmit the claim, and your cash covers the clinician's pay while you wait. Others never get paid. Sort the denied sessions into those two groups.
- Run last quarter again at a percentage of collections. Multiply what each clinician's sessions collected by the percentage you'd pay, then compare that total with what you paid. Under a percentage of collections, nothing goes out for a denied claim until the payer pays. Even a denial your biller caused leaves the clinician unpaid.
Monique Delgado, former chief executive of Integrated Medical Services, a physician group in Arizona, tied the group's pay to collected cash. Each specialty's pay pool started from what that specialty collected, she said. "Collections was very important."
Cash the specialty collected
minus the specialty's expenses
minus a target margin, for the highest-producing specialties
= the specialty's pay pool
Each physician's share: that physician's percentage of the specialty's production
Production: relative value units or collections; the group used both
The steps Monique Delgado described for the pay pools at Integrated Medical Services. A pay pool set this way never pays out money a payer denied.
Set commission rates in JotPsych as a percentage of collections, and the payroll report estimates take-home from collected money.
Book 15 minutes- Monique Delgado, former CEO of Integrated Medical Services, and Eric Passon, CEO of Ancore Health, “Revolutionizing Physician Compensation: Building Sustainable, Value-Driven Models,” session B2, Medical Group Management Association (MGMA) 2026 Annual Conference, San Antonio, September 28, 2026.
- David Raths, “Arizona Physician Group IMS Builds Foundation for Value-Based Care Success,” Healthcare Innovation, March 19, 2024.
- Justin Lo, Michelle Long, Rayna Wallace, Meghan Salaga, and Kaye Pestaina, “Claims Denials and Appeals in ACA Marketplace Plans in 2023,” KFF, January 27, 2025, updated March 24, 2026.