Revenue leakage in healthcare refers to earned reimbursement that a provider does not collect—not because care was inappropriate or undocumented, but because payment breaks down somewhere between service delivery and final adjudication.
In simple terms: The work was done, but the money never arrived.
Revenue leakage is often discussed as a billing or collections problem, but that framing misses the reality. Many losses occur well before a claim is denied, and others happen after a claim is technically “paid.”
Why Revenue Leakage Is Hard to See
Some revenue losses are obvious. For example, a claim is denied, a balance ages out, or a patient account becomes bad debt.
Other losses are quieter:
- A payer reduces an allowed amount without triggering a denial.
- A service is documented but never billed.
- A secondary claim is never generated.
- A payment posts as “complete” even though it does not match contract terms.
Because these losses do not always create errors, worklists, or alerts, they are often accepted as normal variation rather than identified as leakage.
A Term That Covers More Than Denials
Revenue leakage is not a single failure and not a single department’s responsibility. It is a broad category that includes both visible and invisible loss across the revenue cycle, from front-end data capture to payer adjudication to patient billing.
That breadth is precisely why it is difficult to measure with standard reports.
Where to Go Deeper
This overview simply defines the term. It does not attempt to diagnose causes or prescribe fixes.
For a detailed breakdown of where revenue actually leaks, why those failures persist, and how and how those loss patterns are identified in practice, see our comprehensive framework: Where Revenue Is Leaking in Healthcare—and Why No One Sees It
In that article, we examine both well-known failure points and lesser-known leakage that rarely appears in dashboards or denial reports.
