Ghost Revenue: How to Claim Earned but Unrealized Dollars

Ghost Revenue is the warranted but unrealized revenue that never reaches your books. It slips through the cracks of insufficient revenue cycle infrastructure or fragmented processes. It’s often overlooked because it doesn’t appear on your balance sheet or P&L, making it one of the most dangerous forms of revenue loss.

These dollars are tied to care you’ve already provided but never fully captured, often because of incorrect patient status, insufficient documentation, or missed peer-to-peer escalations. This kind of leakage happens daily in hospitals nationwide, usually without leadership even realizing it.

What Causes Ghost Revenue?

Several systemic and behavioral factors contribute:

• Inappropriate use of Observation for patients who qualify for Inpatient status via medical necessity. A common cause for this is poorly defined escalation criteria for Physician Advisor review for status determinations.
• Under-resourced utilization management teams that lack the time or tools to correct misclassified admissions.
• Over-reliance on scoring tools without human review and strategic intervention.
• Behavioral economics at play in which: teams become conditioned by repeated payor denials and begin to status patients based on what they believe the payor will deny instead of what is medically appropriate.

Here’s the Reality

For an 800-bed academic hospital, even a 1% increase in appropriate Inpatient admissions can add an incremental $1.2 million in annual net income.

That’s not a theory. That’s math.

And it’s the kind of growth that doesn’t require seeing more patients or billing higher charges. It’s about capturing what you’ve already earned, compliantly, accurately, defensibly, and proactively.

How to Claim Your Revenue

Brundage Group’s Physician Advisors are trained and experienced at identifying and correcting these missed opportunities before they become missed revenue. We leverage:

• Proactive documentation support
• Real-time analytics
• Tech-enabled processes
• Deep payor strategy expertise

This combination helps prevent ghost revenue from haunting your bottom line. More importantly, it supports compliance and allows hospitals to bill confidently for the quality care they’ve delivered.

Stop Ghost Revenue in its Tracks

Leadership teams can no longer afford to see Physician Advisor services as optional overhead. When structured correctly, this role becomes powerful engine for both revenue preservation and generation.